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1. Model-based assessment of Chikungunya and O’nyong-nyong virus circulation in Mali in a serological cross-reactivity context

Author

Hozé, Nathanaël, Diarra, Issa, Sangaré, Abdoul Karim, Pastorino, Boris, Pezzi, Laura, Kouriba, Bourèma, Sagara, Issaka, Dabo, Abdoulaye, Djimdé, Abdoulaye, Thera, Mahamadou Ali, Doumbo, Ogobara K., de Lamballerie, Xavier, Cauchemez, Simon, Modélisation mathématique des maladies infectieuses - Mathematical modelling of Infectious Diseases, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Unité des Virus Emergents (UVE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Malaria Research and Training Center [Bamako, Mali], Université de Bamako, Centre d'Infectiologie Charles Mérieux, Bamako, Mali, Laboratoire de Virologie [UNIV Corse-Inserm] (EA7310), Université Pascal Paoli (UPP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Nathanaël Hozé and Simon Cauchemez acknowledge financial support from the AXA Research Fund, the Investissement d’Avenir program, the Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases program (Grant ANR-10-LABX-62-IBEID), the INCEPTION project (PIA/ANR-16-CONV-0005), We thank the European Union’s Horizon 2020 research and innovation program under ZIKAlliance grant agreement No. 734548 and the Minister of Health and Hygiene of Mali supported this work through the subvention no. 2016/668116-0 from the Mali World Health Organization Local Office., We dedicate this article to Ogobara K. Doumbo, who initiated this project before he passed. May he rest in peace. We thank Christine Isnard from EFS, Marseille for invaluable technical contribution. We are grateful to Ismaila Thera, from MRTC, Bamako who developed the electronic database using ODK and provided the data management service for the study. We also thank the study district health officers and the study population for their cooperation. Specifically, we are indebted to Hamma Maiga, Bakary Sidibé, Modibo Diarra, Kassoum Kayentao, Souleymane Dama, Hamidou Niangaly, Amadou Bamadio, Hamadoun Diaité, Karim Traoré and Balla Diarra for their support to field investigations., ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010), ANR-16-CONV-0005,INCEPTION,Institut Convergences pour l'étude de l'Emergence des Pathologies au Travers des Individus et des populatiONs(2016), European Project: 734548,ZIKAlliance(2016), Limouzin, Cécile, Integrative Biology of Emerging Infectious Diseases - - IBEID2010 - ANR-10-LABX-0062 - LABX - VALID, Institut Convergences pour l'étude de l'Emergence des Pathologies au Travers des Individus et des populatiONs - - INCEPTION2016 - ANR-16-CONV-0005 - CONV - VALID, A global alliance for Zika virus control and prevention - ZIKAlliance - 2016-10-01 - 2019-09-30 - 734548 - VALID, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pascal Paoli (UPP)

Subjects
Statistical methods, Viral epidemiology, Epidemiology, viruses, Science, MESH: Algorithms, [MATH] Mathematics [math], MESH: Chikungunya Fever, Cross Reactions, Mali, Sensitivity and Specificity, Article, MESH: Cross Reactions, Seroepidemiologic Studies, MESH: Martinique, parasitic diseases, Humans, O'nyong-nyong Virus, Martinique, [MATH]Mathematics [math], Models, Statistical, MESH: Seroepidemiologic Studies, MESH: Humans, Reproducibility of Results, virus diseases, MESH: Chikungunya virus, MESH: Mali, MESH: Sensitivity and Specificity, MESH: O'nyong-nyong Virus, MESH: Reproducibility of Results, Viral infection, Chikungunya Fever, Chikungunya virus, Algorithms, MESH: Models, Statistical
Abstract

Serological surveys are essential to quantify immunity in a population but serological cross-reactivity often impairs estimates of the seroprevalence. Here, we show that modeling helps addressing this key challenge by considering the important cross-reactivity between Chikungunya (CHIKV) and O’nyong-nyong virus (ONNV) as a case study. We develop a statistical model to assess the epidemiology of these viruses in Mali. We additionally calibrate the model with paired virus neutralization titers in the French West Indies, a region with known CHIKV circulation but no ONNV. In Mali, the model estimate of ONNV and CHIKV prevalence is 30% and 13%, respectively, versus 27% and 2% in non-adjusted estimates. While a CHIKV infection induces an ONNV response in 80% of cases, an ONNV infection leads to a cross-reactive CHIKV response in only 22% of cases. Our study shows the importance of conducting serological assays on multiple cross-reactive pathogens to estimate levels of virus circulation., O’nyong nyong and Chikungunya virus are arboviruses present in Africa but their prevalence is unknown, partly due to high antibody cross-reactivity with one another. Here, the authors develop a statistical model that accounts for cross-reactivity to characterise circulation of both viruses from seroprevalence surveys.

Published
2021
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2. Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas

Author

Yoann Madec, Cécile Herrmann-Storck, Arnaud Fontanet, Bruno Hoen, Caroline Callier, Raymond Césaire, Dominique Rousset, Alice Monthieux, Cédric Laouénan, Manon Boullard, Anna L. Funk, Maylis Douine, S. Stegmann-Planchard, Benoit Tressières, Bruno Schaub, Fatiha Najioullah, Jean-Luc Voluménie, Eustase Janky, André Cabié, Gabriel Carles, Kinda Schepers, Samson Yassinguezo, Sylvie Cassadou, Vanessa Ardillon, Philippe Kadhel, Mathieu Nacher, Catherine Ryan, CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre d'investigation clinique Antilles-Guyane (CIC - Antilles Guyane), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de la Martinique [Fort de France]-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Université des Antilles et de la Guyane (UAG), Maison de la Femme de la Mère et de l'Enfant [CHU de la Martinique] (MFME [Fort de France]), CHU de la Martinique [Fort de France], Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Santé publique France - French National Public Health Agency [Saint-Maurice, France], Centre Hospitalier de l'Ouest Guyanais Franck Joly [Saint-Laurent-du-Maroni, Guyane Française], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université des Antilles et de la Guyane - UFR des sciences médicales (UAG UFR SM), Institut Pasteur de la Guyane, Réseau International des Instituts Pasteur (RIIP), Maladies infectieuses et tropicales dans la Caraïbe (MAITC EA 4537), CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de la Martinique [Fort de France]-Université des Antilles (UA), Centre Hospitalier Louis Constant Fleming, Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Center for Global Health Research and Education - Centre pour la Recherche et la Formation en Santé Mondiale (CGH), Institut Pasteur [Paris] (IP)-Réseau International des Instituts Pasteur (RIIP), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Supported by the French Ministry of Health (Soutien Exceptionnel à la Recherche et à l’Innovation), by a grant (ANR-10-LABX-62-IBEID) from Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases project, by the ZIKAlliance consortium (the European Union’s Horizon 2020 Research and Innovation Program), and by INSERM. This study is part of the ZIKAlliance consortium project., We thank the women who participated in this study, all the physicians, midwives, clinical research assistants, health officers, and epidemiologists who helped conduct this study in each of the French territories in the Americas: Myriam Atine, Lyderic Aubert, Marie Barrau, Kebe Beavogui, Christelle Celeste, Joelle Colat-Peyron, Elvire Couchy, Véronique Davidas, Lucetta Delver, Jacqueline Dubois, Stanie Gaete, Dorothée Harrois, Marie-Laure Lalanne-Mistrih, Mathilde Melin, Marie-France Mirane, Francelise Nadessein, Marie-Josée Pelczar, Véronique Plantier, Céline Rocquet, Magdalena Saint-Marc, Patrick Saint-Martin, Valérie Soter, Ingrid Soubdhan, Jennifer Taillefond, Lambo Velonasy, and Véronique Walter (Guadeloupe), Nicole Ambroisine, Gilda Belrose, Alain Blateau, Patricia Blondel, Isabelle Calmont, Valérie Decatrelle, Michèle Gueneret, Eugénie Jolivet, Isabelle Komla-Soukha, Corinne Plavonil, Marie-andrée Pyram, and Jean-Luc Voluménie (Martinique), Antoine Adenis, Audrey Andrieu, Luisiane Carvalho, Sandy Dabrowski, Céline Delorme, Maryvonne Dueymes, Aniza Fahrasmane, Arthur Felix, Hélène Hilderal, Anne Jolivet, Justine Krajewsky, Véronique Lambert, Thomas Lemaitre, Myriam Livain, Jérémie Pasquier, Marion Petit-Sinturel, Céline Pomar, Léo Pomar, and Stéphanie Rogier (French Guiana), and David Baud (University of Lausanne, Switzerland) and Rebecca Grant (Institut Pasteur de Paris, France) for their critical review of an earlier version of the manuscript., ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010), Jonchère, Laurent, Integrative Biology of Emerging Infectious Diseases - - IBEID2010 - ANR-10-LABX-0062 - LABX - VALID, Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU de la Martinique [Fort de France]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Université des Antilles (UA)-CHU de la Martinique [Fort de France], and Réseau International des Instituts Pasteur (RIIP)-Institut Pasteur [Paris]

Subjects
0301 basic medicine, Microcephaly, [SDV]Life Sciences [q-bio], Chromosome Disorders, MESH: Amniotic Fluid, Zika virus, Cohort Studies, 0302 clinical medicine, MESH: Pregnancy, Pregnancy, MESH: Martinique, ZikV Infection, Medicine, 030212 general & internal medicine, Pregnancy Complications, Infectious, Prospective cohort study, Guadeloupe, MESH: Cohort Studies, MESH: Chromosome Disorders, MESH: Middle Aged, biology, Zika Virus Infection, Obstetrics, MESH: Infant, Newborn, Pregnancy Outcome, Gestational age, MESH: Congenital Abnormalities, General Medicine, Middle Aged, French Guiana, 3. Good health, [SDV] Life Sciences [q-bio], Fetal Diseases, MESH: Fetal Diseases, MESH: Young Adult, Cohort, Female, Pregnancy Trimesters, Adult, medicine.medical_specialty, Adolescent, MESH: Zika Virus, Article, MESH: Microcephaly, Congenital Abnormalities, Young Adult, 03 medical and health sciences, MESH: Zika Virus Infection, MESH: French Guiana, Humans, MESH: Guadeloupe, Martinique, MESH: Pregnancy Complications, Infectious, Pregnancy outcomes, MESH: Adolescent, Fetus, MESH: Humans, business.industry, Infant, Newborn, MESH: Adult, Zika Virus, Amniotic Fluid, medicine.disease, biology.organism_classification, MESH: Pregnancy Outcome, Confidence interval, 030104 developmental biology, business, MESH: Female, MESH: Pregnancy Trimesters
Abstract

International audience; BACKGROUND:The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas.METHODS:From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort.RESULTS:Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001).CONCLUSIONS:Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).

Published
2018
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3. Combination of ELISA screening and seroneutralisation tests to expedite Zika virus seroprevalence studies

Author

Christophe N. Peyrefitte, Audrey Dubot-Pérès, Paola Mariela Saba Villarroel, Xavier de Lamballerie, Laetitia Ninove, Yelin Roca, Stéphane Priet, Elif Nurtop, Gilda Grard, Bouba Gake, Pierre Gallian, Jan Felix Drexler, Boris Pastorino, Unité des Virus Emergents (UVE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centro Nacional de Enfermedades Tropicales [Santa Cruz de la Sierra, Bolivia] (CENETROP), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur (RIIP), Institut de Recherche pour le Développement (IRD), Institut de Recherche Biomédicale des Armées [Antenne Marseille] (IRBA), Etablissement Français du Sang - Alpes-Méditerranée (EFS - Alpes-Méditerranée), Etablissement Français du Sang, This work was partially supported by the European Union’s Horizon 2020 Research and Innovation Programme under ZIKAlliance Grant Agreement no. 734548 and the European Virus Archive EVAg, European Union- Horizon 2020 programme under grant agreement no. 653316., European Project: 734548,ZIKAlliance(2016), European Project: 653316,H2020,H2020-INFRAIA-2014-2015,EVAg(2015), Dubois Frid, Caroline, A global alliance for Zika virus control and prevention - ZIKAlliance - 2016-10-01 - 2019-09-30 - 734548 - VALID, and European Virus Archive goes global - EVAg - - H20202015-04-01 - 2019-03-31 - 653316 - VALID

Subjects
0301 basic medicine, viruses, Antibodies, Viral, Zika virus, Dengue fever, MESH: Antibodies, Neutralizing, Cytopathogenic Effect, Viral, Seroepidemiologic Studies, MESH: Martinique, Combination strategy, Mass Screening, Cytopathic effect, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, MESH: Immunoglobulin G, education.field_of_study, Microscopy, biology, Zika Virus Infection, MESH: Neutralization Tests, MESH: Enzyme-Linked Immunosorbent Assay, 3. Good health, Infectious Diseases, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, MESH: Microscopy, Population, Virus Neutralization, Enzyme-Linked Immunosorbent Assay, MESH: Zika Virus, Sensitivity and Specificity, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, MESH: Zika Virus Infection, Neutralization Tests, Virology, medicine, Seroprevalence, Humans, lcsh:RC109-216, Martinique, Serologic Tests, MESH: Mass Screening, education, Igg elisa, Seroepidemiology, MESH: Seroepidemiologic Studies, MESH: Humans, MESH: Serologic Tests, Correction, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, medicine.disease, MESH: Cytopathogenic Effect, Viral, Antibodies, Neutralizing, MESH: Sensitivity and Specificity, 030104 developmental biology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Immunoglobulin G, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Virus neutralization test, MESH: Antibodies, Viral
Abstract

International audience; Here we propose a strategy allowing implementing efficient and practicable large-scale seroepidemiological studies for Zika Virus (ZIKV). It combines screening by a commercial NS1 protein-based Zika IgG ELISA, and confirmation by a cytopathic effect-based virus neutralization test (CPE-based VNT). In post-epidemic samples from Martinique Island blood donors (a population with a dengue seroprevalence above 90%), this strategy allowed reaching specificity and sensitivity values over 98%. The CPE-based VNT consists of recording CPE directly under the optical microscope, which is easy to identify with ZIKV strain H/PF/2013 at day 5 pi. Overall, considered that CPE-based VNT is cost effective and widely automatable, the NS1 protein-based Zika IgG ELISA+CPE-based VNT combination strategy represents a convenient tool to expedite ZIKV seroprevalence studies.

Published
2018
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4. Meta-Analysis on the Use of Zidovudine and Interferon-Alfa in Adult T-Cell Leukemia/Lymphoma Showing Improved Survival in the Leukemic Subtypes

Author

William J. Harrington, Yves Plumelle, Olivier Hermine, Graham P. Taylor, Juan Carlos Ramos, Patricia Tortevoye, Antoine Gessain, Gérard Panelatti, Ali Bazarbachi, Zaher K. Otrock, Pathologie et virologie moléculaire ( PVM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Service d'Hematologie Biologique, CHU Fort de France, Imperial College London, Cytokines, hématopoïèse et réponse immune ( CHRI ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), American University of Beirut [Beyrouth] (AUB), CHU de la Martinique [Fort de France], University of Miami [Coral Gables], Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Départment d'Hématologie, Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Pathologie et virologie moléculaire (PVM (UMR_7151)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Cytokines, hématopoïèse et réponse immune (CHRI), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Pathologie et virologie moléculaire (PVM), and Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Oncology, Cancer Research, Time Factors, MESH: Chi-Square Distribution, viruses, Kaplan-Meier Estimate, MESH: Risk Assessment, MESH: Proportional Hazards Models, MESH: Aged, 80 and over, 0302 clinical medicine, Risk Factors, MESH: Martinique, MESH: Risk Factors, immune system diseases, hemic and lymphatic diseases, Antineoplastic Combined Chemotherapy Protocols, Mogamulizumab, Leukemia-Lymphoma, Adult T-Cell, Medicine, Survivors, MESH: Kaplan-Meiers Estimate, MESH: Leukemia-Lymphoma, Adult T-Cell, ComputingMilieux_MISCELLANEOUS, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, MESH: Survivors, 0303 health sciences, MESH: Middle Aged, MESH: Zidovudine, Middle Aged, 3. Good health, MESH: Antineoplastic Combined Chemotherapy Protocols, Leukemia, Treatment Outcome, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Young Adult, 030220 oncology & carcinogenesis, MESH: Great Britain, Female, MESH: Interferon-alpha, Zidovudine, Martinique, medicine.drug, Adult, MESH: Antiviral Agents, medicine.medical_specialty, Adolescent, Alpha interferon, Antiviral Agents, Risk Assessment, Adult T-cell leukemia/lymphoma, Young Adult, 03 medical and health sciences, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, MESH: United States, Humans, Interferon alfa, Aged, Proportional Hazards Models, Retrospective Studies, 030304 developmental biology, MESH: Adolescent, Chi-Square Distribution, MESH: Humans, business.industry, MESH: Time Factors, Interferon-alpha, MESH: Adult, MESH: Retrospective Studies, medicine.disease, United Kingdom, United States, MESH: Male, Lymphoma, Immunology, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Purpose Human T-cell lymphotropic virus type-I–associated adult T-cell leukemia/lymphoma (ATL) is an aggressive, chemotherapy-resistant malignancy. Multiple small studies using zidovudine (AZT) and interferon-alfa (IFN-α) have shown response in patients with ATL. However, the impact of this innovative antiviral treatment strategy on long-term survival remains undetermined. Patients and Methods We report a meta-analysis of antiviral therapy of ATL. Medical records of 254 patients with ATL who were treated in the United States, the United Kingdom, Martinique, and continental France were individually reviewed. Results According to Shimoyama classification, there were 116 patients with acute ATL, 18 patients with chronic ATL, 11 patients with smoldering ATL, and 100 patients with ATL lymphoma. In 231 patients with available survival data, first-line therapy was recorded in 207 patients. Five-year overall survival rates were 46% for 75 patients who received first-line antiviral therapy (P = .004), 20% for 77 patients who received first-line chemotherapy, and 12% for 55 patients who received first-line chemotherapy followed by antiviral therapy. Patients with acute, chronic, and smoldering ATL significantly benefited from first-line antiviral therapy, whereas patients with ATL lymphoma experienced a better outcome with chemotherapy. In acute ATL, achievement of complete remission with antiviral therapy resulted in 82% 5-year survival. Antiviral therapy in chronic and smoldering ATL resulted in 100% 5-year survival. Multivariate analysis confirmed that first-line antiviral therapy significantly improves overall survival of patients with ATL (hazard ratio, 0.47; 95% CI, 0.27 to 0.83; P = .021). Conclusion These results confirm the high efficacy of AZT and IFN, which should now be considered the gold standard first-line therapy in leukemic subtypes of ATL.

Published
2010
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5. Multiple sclerosis and solar exposure before the age of 15 years: case—control study in Cuba, Martinique and Sicily

Author

François Dalmay, JA Cabrera-Gómez, Devender Bhalla, Alessandra Nicoletti, Michel Dumas, F. Ruiz, Michel Druet-Cabanac, P. Cabre, Pierre-Marie Preux, Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Service de Santé au Travail [CHU Limoges], CHU Limoges, Unité Fonctionnelle Registre Général des Cancers du Limousin (UFRGC), and Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME)

Subjects
Male, Pediatrics, Neurological disorder, MESH: Cuba, Poser criteria, 0302 clinical medicine, MESH: Martinique, Epidemiology, Family history, Sicily, MESH: Sicily, MESH: Aged, 0303 health sciences, education.field_of_study, MESH: Middle Aged, Cuba, Middle Aged, MESH: Case-Control Studies, Neurology, MESH: Young Adult, Sunlight, Female, Martinique, Adult, MESH: Sunlight, medicine.medical_specialty, Multiple Sclerosis, Adolescent, Ultraviolet Rays, Population, Young Adult, 03 medical and health sciences, medicine, Humans, education, Aged, 030304 developmental biology, MESH: Adolescent, MESH: Humans, business.industry, Multiple sclerosis, MESH: Adult, MESH: Multiple Sclerosis, Odds ratio, medicine.disease, MESH: Male, Case-Control Studies, MESH: Ultraviolet Rays, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery
Abstract

International audience; Few studies report a protective role of childhood solar exposure to multiple sclerosis. Our objective was to confirm the protective role of childhood solar exposure in multiple sclerosis in Cuba, Martinique and Sicily. This was a matched case- control study, and cases met Poser criteria for clinically, laboratory (definite, probable) multiple sclerosis. Controls were resident population, without neurological disorder, living close to cases (within 100 km), matched for sex, age (+/-5 years), residence before age 15. We recruited 551 subjects during a 1-year period (193 cases, Cuba n = 95, Sicily n = 50, Martinique n = 48; 358 controls). Some (89%) met definite clinical multiple sclerosis criteria (relapsing remitting form (with and without sequel) (74%), secondary progressive (21%), primary progressive (5%)). Odds ratios in a uni-variate analysis were: family history of multiple sclerosis (5.1) and autoimmune disorder (4.0); wearing shirt (3.5), hat (2.7), pants (2.4); sun exposure causing sunburn (1.8); sun exposure duration (1 h more/day; weekends 0.91, weekdays 0.86); bare-chested (0.6); water sports (0.2). Independent factors in the multivariate analysis were family history of multiple sclerosis (4.8 (1.50-15.10)), wearing pants under sunlight (1.9 (1.10-3.20)), sun exposure duration (1 h more/ day, weekdays 0.90 (0.85-0.98), weekends 0.93 (0.87-0.99)), water sports (0.23 (0.13-0.40)). We conclude that outdoor leisure activities in addition to sun exposure reports are associated with a reduced multiple sclerosis risk, with evidence of dose response.

Published
2010
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6. Factors Associated with Severe Leptospirosis, Martinique, 2010–2013

Author

Mathieu Picardeau, Isabelle Lamaury, Guillaume Hurtrel, Jean-Marie Delord, Ruddy Valentino, Roland Martinez, Pascale Bourhy, Patrick Hochedez, Hossein Mehdaoui, Claude Olive, Rafaelle Théodose, Nicolas Vignier, Cécile Herrmann, Raymond Césaire, André Cabié, Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Université des Antilles et de la Guyane (UAG), Centre Collaborateur FAO/OMS pour l'épidémiologie de la leptospirose, Institut Pasteur [Paris] (IP), Centre National de Référence de la Leptospirose - National Reference Center Leptospirosis (CNR), Biologie des Spirochètes / Biology of Spirochetes, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier de Trinité MARTINIQUE, Centre hospitalier du Lamentin MARTINIQUE, CHU Pointe-à-Pitre/Abymes [Guadeloupe], Institut National de la Santé et de la Recherche Médicale (INSERM), We also thank the French Ministry of Health with the participation of the Groupement Interrégional de Recherche Clinique et d’Innovation Sud-Ouest Outre-Mer for funding and the Direction de la Recherche Clinique et de Innovation of the University Hospital of Fort-de-France, Martinique, France, for methodologic support., We thank Olivier Verlaeten and Ludovic Jeanneau, who introduced the qPCR technique in the University Hospital of Fort de France, Dorothée Haug and the technical staff at the Service de Bactériologie of the University Hospital of Fort-de-France, Janick Jean-Marie and the staff at the Centre d’Investigation Clinique et d’Epidémiologie Clinique Antilles-Guyane (Institut National de la Santé et de la Re- cherche Médicale CIE 802), Christopher Pappas for editorial assistance, and Eric Caumes for critical review of the manu- script., MURGUET, SYLVIE, and Institut Pasteur [Paris]

Subjects
Male, Serotype, Epidemiology, [SDV]Life Sciences [q-bio], lcsh:Medicine, Disease Outbreaks, MESH: Dogs, 0302 clinical medicine, MESH: Martinique, Zoonoses, MESH: Animals, Dog Diseases, MESH: Disease Outbreaks, bacteria, 0303 health sciences, MESH: Middle Aged, medicine.diagnostic_test, biology, Dispatch, Factors Associated with Severe Leptospirosis, Martinique, 2010–2013, MESH: Leptospirosis, Middle Aged, Leptospirosis, 3. Good health, [SDV] Life Sciences [q-bio], qPCR, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, severe leptospirosis, Female, medicine.symptom, MESH: Zoonoses, Martinique, Leptospira interrogans, Adult, Microbiology (medical), MESH: Dog Diseases, 030231 tropical medicine, leptospiremia, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Dogs, Disease severity, medicine, Animals, Humans, lcsh:RC109-216, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Prothrombin time, MESH: Humans, 030306 microbiology, business.industry, lcsh:R, MESH: Adult, Auscultation, medicine.disease, biology.organism_classification, serogroup Icterohaemorrhagiae, MESH: Male, Immunology, quantitative PCR, Anuria, business, MESH: Female
Abstract

International audience; To identify factors associated with disease severity, we examined 102 patients with quantitative PCR-confirmed leptospirosis in Martinique during 2010-2013. Associated factors were hypotension, chest auscultation abnormalities , icterus, oligo/anuria, thrombocytopenia, prothrombin time

Published
2015
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7. Outbreak of leptospirosis among canyoning participants, Martinique, 2011

Author

Jacques Rosine, R. Théodose, André Cabié, Martine Ledrans, Pascale Bourhy, L. Pasgrimaud, Patrick Hochedez, H. Decoussy, Mathieu Picardeau, R Martinez, Claude Olive, M. Escher, Infectious and Tropical Diseases Unit, Fort-de-France University Hospital, Regional Office of the French Institute for Public Health Surveillance, Institut de Veille Sanitaire (INVS), European Programme for Intervention Epidemiology Training, EPIET, French Armed Forces in the French West Indies, Department of Medicine, Trinité Hospital, Laboratory for Microbiology, Centre Collaborateur FAO/OMS pour l'épidémiologie de la leptospirose, Institut Pasteur [Paris], Centre National de Référence de la Leptospirose - National Reference Center Leptospirosis (CNR), Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG), Institut Pasteur and the French Institute for Public Health Surveillance (InVS), Institut Pasteur [Paris] (IP), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], and ADENIS, ANTOINE

Subjects
MESH: Mountaineering, Male, Veterinary medicine, Time Factors, Epidemiology, MESH: Leptospira, Disease Outbreaks, 0302 clinical medicine, MESH: Risk Factors, MESH: Martinique, Risk Factors, Surveys and Questionnaires, Medicine, Young adult, MESH: Disease Outbreaks, Medical attention, Leptospira, 0303 health sciences, MESH: Middle Aged, biology, MESH: Real-Time Polymerase Chain Reaction, MESH: Patient Acceptance of Health Care, MESH: Leptospirosis, Middle Aged, Leptospirosis, 3. Good health, MESH: Young Adult, Female, Martinique, Adult, medicine.medical_specialty, 030231 tropical medicine, Real-Time Polymerase Chain Reaction, Sensitivity and Specificity, 03 medical and health sciences, Young Adult, Virology, Internal medicine, Humans, MESH: Humans, 030306 microbiology, business.industry, Public health, MESH: Questionnaires, MESH: Time Factors, Public Health, Environmental and Occupational Health, Outbreak, MESH: Adult, Patient Acceptance of Health Care, biology.organism_classification, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, Mountaineering, Leptospira species, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

International audience; Two gendarmes who participated in canyoning activities on 27 June 2011 on the Caribbean island of Martinique were diagnosed with leptospirosis using quantitative real-time polymerase chain reaction (qPCR), 9 and 12 days after the event. Among the 45 participants who were contacted, 41 returned a completed questionnaire, of whom eight met the outbreak case definition. The eight cases sought medical attention and were given antibiotics within the first week after fever onset. No severe manifestations of leptospirosis were reported. In seven of the eight cases, the infection was confirmed by qPCR. Three pathogenic Leptospira species, including L. kmetyi, were identified in four of the cases. None of the evaluated risk factors were statistically associated with having developed leptospirosis. Rapid diagnostic assays, such as qPCR, are particularly appropriate in this setting - sporting events with prolonged fresh-water exposure - for early diagnosis and to help formulate public health recommendations. Participants in such events should be made specifically aware of the risk of leptospirosis, particularly during periods of heavy rainfall and flooding.

Published
2013
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8. Pesticides et cancer de la prostate : données épidémiologiques [Pesticides and prostate cancer: epidemiological data]

Author

Ndong, Jean-Rodrigue, Blanchet, Pascal, Multigner, Luc, Groupe d'Etude de la Reproduction Chez l'Homme et les Mammiferes (GERHM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'urologie, Université des Antilles et de la Guyane (UAG)-CHU Pointe-à-Pitre/Abymes [Guadeloupe], Forgeron, Christine, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Humans, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Crops, Agricultural, MESH: Occupational Exposure, MESH: Male, [SDV.TOX] Life Sciences [q-bio]/Toxicology, [SDV.CAN] Life Sciences [q-bio]/Cancer, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Martinique, MESH: Musa, MESH: Prostatic Neoplasms, [SDV.TOX]Life Sciences [q-bio]/Toxicology, MESH: Guadeloupe, MESH: Meta-Analysis as Topic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Agricultural Workers' Diseases, MESH: Pesticides, MESH: Cohort Studies
Abstract

International audience; Prostate cancer is the most frequent cancer affecting men in most Western countries. Certain risk factors have been identified (age, family history, ethnic origin), but the aetiology of this cancer remains largely unknown. However, a role for environmental factors is strongly suspected. Questions have been raised concerning the role of the chemical substances generated by human activities in the occurrence of this disease. Diverse studies have consistently demonstrated a higher risk of prostate cancer in agricultural populations than in the general population. The hypothesis that this higher risk is linked to the use of pesticides has been tested in a number of studies, mostly in North America and Europe. However, to date, with a few possible exceptions, it has been impossible to demonstrate a significant association between exposure to pesticides or a chemical family of pesticides and prostate cancer. In the face of these uncertainties, rigorous studies are required, with objective measurements of exposure, taking into account confounding factors and individual risk factors, making it possible to assess gene-environment interactions.

Published
2009
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9. Incidence et mortalité des cancers gynécologiques en Guadeloupe [Incidence and mortality of gynaecological cancers in Guadeloupe (French West Indies)]

Author

Kadhel, Philippe, Janky, Eustase, Multigner, Luc, Groupe d'Etude de la Reproduction Chez l'Homme et les Mammiferes (GERHM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service de gynécologie-obstétrique, Université des Antilles et de la Guyane (UAG)-CHU Pointe-à-Pitre/Abymes [Guadeloupe], Forgeron, Christine, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Aged, MESH: Middle Aged, MESH: Humans, MESH: Uterine Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Uterine Cervical Neoplasms, MESH: France, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Ovarian Neoplasms, [SDV.CAN] Life Sciences [q-bio]/Cancer, MESH: Martinique, MESH: Guadeloupe, MESH: Incidence, MESH: Age Distribution, MESH: Female, MESH: Breast Neoplasms
Abstract

International audience; The principal gynaecological cancers (breast, ovary, uterus, and cervix) account for over 40% of cancers found in women worldwide. However, large differences exist, in both their incidence and geographical distribution. The French West Indies, through their location, environment, socio-economic development, lifestyle, nutrition and the origins of their populations, constitute territories with a very particular character in the heart of the Caribbean. These characteristics have an impact on public health and can affect the incidence of tumours. We report for the first time the incidence of these major gynaecological cancers in Guadeloupe. Breast, ovary and uterine cancers have lower incidences in Guadeloupe than in mainland France. By contrast, cervical cancer is more frequent in Guadeloupe than in mainland France. The mortality rates associated with breast cancer, ovary and uterine cancer are also lower in Guadeloupe than in mainland France, whereas the opposite pattern is observed for cervical cancer. These observations may be accounted for in part by a difference in the prevalence of established or suspected risk factors for each of these types of cancer.

Published
2009
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10. Hybridization and invasiveness in the freshwater snail Melanoides tuberculata: hybrid vigour is more important than increase in genetic variance

Author

Facon, B., Jarne, P., Pointier, J. P., David, P., Department of Ecology and Evolution [Lausanne], Université de Lausanne (UNIL), Centre d’Ecologie Fonctionnelle et Evolutive (CEFE), Université Paul-Valéry - Montpellier 3 (UPVM)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Laboratoire de biologie marine et malacologie, Université de Perpignan Via Domitia (UPVD)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Department of Ecology and Evolution, Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-École pratique des hautes études (EPHE)-Université de Montpellier (UM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-Université Paul-Valéry - Montpellier 3 (UM3), and Université de Perpignan Via Domitia (UPVD)-École pratique des hautes études (EPHE)-Centre National de la Recherche Scientifique (CNRS)

Subjects
MESH: Selection (Genetics), Snails, MESH: Genetics, Population, Fresh Water, MESH: Research Support, Non-U.S. Gov't, MESH: Phenotype, MESH: Hybrid Vigor, Thiaridae, MESH: Demography, MESH: Martinique, MESH: Analysis of Variance, Hybrid Vigor, heterosis, Animals, Body Size, Martinique, MESH: Animals, Selection, Genetic, parthenogenesis, MESH: Snails, hybridization, Demography, Analysis of Variance, invasive snails, MESH: Body Size, [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Genetic Variation, MESH: Fertility, MESH: Comparative Study, life-history traits, MESH: Hybridization, Genetic, Fertility, Genetics, Population, Phenotype, invasion success, MESH: Fresh Water, Hybridization, Genetic, MESH: Variation (
Abstract

Many invasive taxa are hybrids, but how hybridization boosts the invasive process remains poorly known. We address this question in the clonal freshwater snail Melanoides tuberculata from Martinique, using three parental and two hybrid lines. We combine an extensive field survey (1990-2003) and a quantitative genetic experiment to show that hybrid lines have outcompeted their parents in natural habitats, and that this increased invasiveness co-occurred with pronounced shifts in life-history traits, such as growth, fecundity and juvenile size. Given the little time between hybrid creation and sampling, and the moderate standing genetic variance for life-history traits in hybrids, we show that some of the observed trait changes between parents and hybrids were unlikely to arise only by continuous selection. We therefore suggest that a large part of hybrid advantage stems from immediate heterosis upon hybridization.

Published
2005
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11. Cross-cultural comparison of growth, maturation and adiposity indices of two contrasting adolescent populations in rural Senegal (West Africa) and Martinique (Caribbean)

Author

Denis Garnier, Eric Bénéfice, Nathalie Caïus, and Épidémiologie et prévention : environnement et efficacité des interventions (EPIPREV)

Subjects
Male, OBESITE, PUBERTE, Pediatrics, Medicine (miscellaneous), MESH: Food Habits, Rural Health, ADOLESCENT, Overweight, MESH: Sexual Maturation, MESH: Skinfold Thickness, MESH: Martinique, MESH: Risk Factors, Risk Factors, MESH: Cross-Cultural Comparison, CROISSANCE, MESH: Obesity, Underweight, Sexual Maturation, Body mass index, education.field_of_study, Nutrition and Dietetics, Anthropometry, MESH: Sex Distribution, MALNUTRITION, MESH: Nutrition Assessment, Senegal, PREVALENCE, Skinfold Thickness, Geography, ANTHROPOMETRIE NUTRITIONNELLE, Menarche, Female, medicine.symptom, Martinique, Cross-Cultural Comparison, medicine.medical_specialty, MESH: Socioeconomic Factors, Adolescent, Adolescent Nutritional Physiological Phenomena, Population, Developing countries, CONSOMMATION ALIMENTAIRE, MESH: Anthropometry, MESH: Senegal, ETUDE COMPARATIVE, medicine, overweight, Humans, Obesity, ACTIVITE PHYSIQUE, Sex Distribution, education, Exercise, MESH: Adolescent, MESH: Adolescent Nutrition Physiology, MESH: Humans, Puberty, Body Weight, Public Health, Environmental and Occupational Health, Feeding Behavior, MESH: Rural Health, medicine.disease, MESH: Male, MESH: Body Weight, Nutrition Assessment, Socioeconomic Factors, MESH: Exercise, MATURITE SEXUELLE, MESH: Female, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, Demography
Abstract

Objectives:To stress the importance of social and environment (nutritional) factors in determining the growth spurt during puberty and the risk of excessive adiposity, two contrasting adolescent populations, one from a rural area of Senegal (West Africa) and the other from Martinique (French West Indies), were compared.Design:Cross-cultural comparison of contrasting populations. Adolescents from Senegal belonged to a cohort followed up since 1995. Adolescents from Martinique participated in a cross-sectional nutritional survey that covered the entire island.Subjects:A total of 507 adolescents (mean age: 14.3 ± 0.7 years) from Senegal (319 girls and 188 boys) and 703 adolescents from Martinique (351 boys and 352 girls) were surveyed.Results:Differences in growth and maturation were striking: boys in Martinique were 22.7 kg heavier and 20.1 cm taller than boys in Senegal. Differences were less important for girls but still evident: 12.6 kg in weight and 10.5 cm in stature. In Senegal, there were virtually no overweight adolescents, but 18% of girls and 50% of boys could be considered as malnourished. In Martinique, 19% of girls and 23% of boys were overweight or obese. Adolescent girls from Martinique were also sexually more mature than adolescent girls from Senegal. When comparisons were repeated after Senegalese girls reached menarche, differences in weight and body mass index disappeared, but Senegalese girls were still shorter than girls from Martinique.Conclusions:Adolescents are extremely susceptible to nutritional changes and their particular situation needs to be incorporated into nutritional prevention programmes.

Published
2004
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12. Influence of the dengue serotype, previous dengue infection, and plasma viral load on clinical presentation and outcome during a dengue-2 and dengue-4 co-epidemic

Author

Stéphane Kaidomar, Raymond Césaire, Jenny Martial, Lian F. Thomas, Christiane Fonteau, Olivier Verlaeten, Yves Plumelle, Victor Moravie, Philippe Dussart, Fatiha Najioullah, André Cabié, CHU de la Martinique [Fort de France], Institut Pasteur de la Guyane, Réseau International des Instituts Pasteur (RIIP), and This study was supported by Centre Hospitalier Universitaire de Fort-de-France.

Subjects
Male, Serotype, MESH: Dengue, Antibodies, Viral, MESH: Dengue Virus, Dengue fever, Dengue, 0302 clinical medicine, MESH: Martinique, Surveys and Questionnaires, MESH: Reverse Transcriptase Polymerase Chain Reaction, Epidemiology, Medicine, MESH: Aged, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, 0303 health sciences, MESH: Middle Aged, Reverse Transcriptase Polymerase Chain Reaction, MESH: Enzyme-Linked Immunosorbent Assay, virus diseases, Middle Aged, Viral Load, 3. Good health, Infectious Diseases, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Female, Viral disease, MESH: Viral Load, Viral load, Martinique, Adult, medicine.medical_specialty, Secondary infection, 030231 tropical medicine, Enzyme-Linked Immunosorbent Assay, 03 medical and health sciences, Species Specificity, Virology, Internal medicine, Humans, MESH: Species Specificity, MESH: Surveys and Questionnaires, Aged, MESH: Humans, 030306 microbiology, business.industry, MESH: Adult, Odds ratio, Dengue Virus, medicine.disease, MESH: Male, Immunology, Parasitology, business, MESH: Female, MESH: Antibodies, Viral
Abstract

International audience; Martinique experienced a dengue outbreak with co-circulation of DENV-2 and DENV-4. In an emergency department-based study, we analyzed whether the clinical presentation and outcome of adult patients were related to serotype, immune status, or plasma viral load. Of the 146 adult patients who had confirmed dengue infection, 91 (62.3%) were classified as having classic dengue fever, 11 (7.5%) fulfilled World Health Organization criteria for dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), 21 other patients (14.4%) presented with at least one typical feature of DHF/DSS [i.e., internal hemorrhage, plasma leakage, marked thrombocytopenia (platelet count Յ 50,000 platelets/mm 3) and/or shock], and 23 further patients (15.8%) had unusual manifestations. Four patients died. Severe illness was more frequent in patients with secondary dengue infection (odds ratio, 7.18; 95% confidence interval, 3.1-16.7; P < 0.001). Multivariate regression analysis showed that gastrointestinal symptoms and other unusual manifestations were independently associated with DENV-2 infection, whereas cough and DHF/DSS features were independently associated with secondary immune response. A high plasma viral load was associated with DENV-2 infection, increased serum liver enzymes, and with DHF/DSS features in patients presenting after the third day of illness. The most severe cases of dengue resulted from the combined effects of DENV-2 and secondary infection.

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