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Resume Introduction La Societe de toxicologie clinique (STC) a ete sollicitee par les pouvoirs publics pour produire des recommandations concernant la prise en charge des femmes enceintes exposees au mercure organique et leurs enfants a naitre. Methode Ces recommandations, avec la participation d’experts appartenant a des societes savantes concernees par la prise en charge des femmes enceintes et/ou de leurs enfants, ont ete etablies selon la methodologie des recommandations pour la pratique clinique definie par la Haute Autorite de sante (HAS). Resultats La principale source d’exposition de la population au methylmercure (MeHg) est alimentaire, notamment par la consommation de poissons fortement contamines. Les biomarqueurs d’exposition fiables pour la surveillance de l’impregnation au MeHg des populations sont le mercure total dans les cheveux et dans le sang total. L’effet critique du MeHg est l’alteration des fonctions cognitives resultant d’une exposition prenatale, et 11 μg/g de cheveux la valeur de la concentration capillaire de mercure maternelle, a partir de laquelle cet effet critique peut survenir chez l’enfant. La population prioritaire pour le depistage est celle des femmes en âge de procreer, ainsi que les enfants âges de moins de 7 ans, consommant plus de 2 portions de poissons par semaine, ou residant dans les bourgs isoles de Guyane, particulierement les femmes enceintes et leurs enfants allaites. Un suivi medical est recommande pour les femmes enceintes ayant une concentration capillaire de mercure superieure a 2,5 μg/g de cheveux (limite superieure de l’intervalle de confiance du 95e percentile dans la population francaise) ainsi que pour leurs nouveau-nes. Si la concentration capillaire chez la mere et/ou l’enfant a depasse 11 μg/g, l’enfant doit beneficier d’un suivi neurodeveloppemental. Conclusion Les mesures de reduction alimentaire des expositions sont primordiales : l’indication de la chelation se discute dans les cas ou des effets neurotoxiques severes sont possibles. Dans ces recommandations, la prise en charge d’une exposition maternelle au MeHg ainsi que celle de l’enfant a naitre sont detaillees dans un organigramme.

Resume Contexte et objectifs A la demande de la Direction generale de la sante, la Haute Autorite de sante (HAS), en partenariat avec la Societe de toxicologie clinique (STC) et avec la collaboration de la Societe francaise de medecine du travail (SFMT), la Societe francaise de sante publique (SFSP), la Societe francaise de toxicologie analytique (SFTA) et la Societe francophone de sante-environnement (SFSE) a elabore des recommandations pour le depistage des surexpositions environnementales a l’arsenic inorganique (Asi) et la prise en charge des populations concernees. Methode La methode d’elaboration utilisee est celle des Recommandations pour la pratique clinique (RPC) de la HAS (HAS, 2010). Resultats Les recommandations elaborees identifient : les sites susceptibles d’entrainer des surexpositions environnementales, a partir de la concentration d’Asi dans leur sol ; la fraction des residents qui constitue la population cible du depistage ; les modalites de ce depistage qui utilise le dosage de l’Asi et de ses metabolites dans les urines. En fonction des resultats du primo-depistage, elles precisent les indications et le deroulement de la surveillance biometrologique. Elles indiquent la fraction de la population exposee qui constitue la cible de la recherche de complications de la surexposition environnementale a l’Asi. Elles precisent les modalites de cette recherche. Enfin, elles proposent des mesures pour le traitement et la prevention des contaminations par l’Asi de l’environnement.

International audience; French Guiana is a European ultraperipheric region located on the northern Atlantic coast of South America. It constitutes an important forested region for biological conservation in the Neotropics. Although very sparsely populated, with its inhabitants mainly concentrated on the Atlantic coastal strip and along the two main rivers, it is marked by the presence and development of old and new epidemic disease outbreaks, both research and health priorities. In this review paper, we synthetize 15 years of multidisciplinary and integrative research at the interface between wildlife, ecosystem modification, human activities and sociodemographic development, and human health. This study reveals a complex epidemiological landscape marked by important transitional changes, facilitated by increased interconnections between wildlife, land-use change and human occupation and activity, human and trade transportation, demography with substantial immigration, and identified vector and parasite pharmacological resistance. Among other French Guianese characteristics, we demonstrate herein the existence of more complex multi-host disease life cycles than previously described for several disease systems in Central and South America, which clearly indicates that today the greater promiscuity between wildlife and humans due to demographic and economic pressures may offer novel settings for microbes and their hosts to circulate and spread. French Guiana is a microcosm that crystallizes all the current global environmental, demographic and socioeconomic change conditions, which may favor the development of ancient and future infectious diseases.

Although the development of vaccines for the prevention of arboviral diseases has been a priority in recent years, prevention strategies continue to depend on vector control. Risk maps at scales appropriate for these strategies can provide valuable information to assess entomological risk levels and guide actions. We used a spatio-temporal modeling approach to predict, at the local scale, the risk of homes potentially harboring Aedes aegypti larvae. The model used integrated larvae risk data collected in the field from September 2011 to February 2013, environmental data obtained from very high spatial resolution Pleiades imagery, and daily meteorological data, collected in the city of Matoury in French Guiana. Various environmental and meteorological conditions were identified as risk or protective factors for the presence of immature stages of Aedes aegypti in homes on a given date and used to produce dynamic maps with high spatial and temporal resolution. Aedes vector risk was modeled between 50 and 200 m, around houses, on a time scale of 3 to 5 days. The resulting model was extrapolated to other municipalities with the same characteristics of urbanization during the 2019-2020 dengue epidemic in French Guiana. This work represents a major opportunity to monitor the evolution of vector risk and constitutes information that could be particularly useful for public health authorities in charge of vector control.

Resume Introduction La Societe de toxicologie clinique (STC) a ete sollicitee par les pouvoirs publics pour produire des recommandations concernant la prise en charge des femmes enceintes exposees au mercure organique et leurs enfants a naitre. Methode Ces recommandations, avec la participation d’experts appartenant a des societes savantes concernees par la prise en charge des femmes enceintes et/ou de leurs enfants, ont ete etablies selon la methodologie des recommandations pour la pratique clinique definie par la Haute Autorite de sante (HAS). Resultats La principale source d’exposition de la population au methylmercure (MeHg) est alimentaire, notamment par la consommation de poissons fortement contamines. Les biomarqueurs d’exposition fiables pour la surveillance de l’impregnation au MeHg des populations sont le mercure total dans les cheveux et dans le sang total. L’effet critique du MeHg est l’alteration des fonctions cognitives resultant d’une exposition prenatale, et 11 μg/g de cheveux la valeur de la concentration capillaire de mercure maternelle, a partir de laquelle cet effet critique peut survenir chez l’enfant. La population prioritaire pour le depistage est celle des femmes en âge de procreer, ainsi que les enfants âges de moins de 7 ans, consommant plus de 2 portions de poissons par semaine, ou residant dans les bourgs isoles de Guyane, particulierement les femmes enceintes et leurs enfants allaites. Un suivi medical est recommande pour les femmes enceintes ayant une concentration capillaire de mercure superieure a 2,5 μg/g de cheveux (limite superieure de l’intervalle de confiance du 95e percentile dans la population francaise) ainsi que pour leurs nouveau-nes. Si la concentration capillaire chez la mere et/ou l’enfant a depasse 11 μg/g, l’enfant doit beneficier d’un suivi neurodeveloppemental. Conclusion Les mesures de reduction alimentaire des expositions sont primordiales : l’indication de la chelation se discute dans les cas ou des effets neurotoxiques severes sont possibles. Dans ces recommandations, la prise en charge d’une exposition maternelle au MeHg ainsi que celle de l’enfant a naitre sont detaillees dans un organigramme.

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

International audience; Background - Residents living close to agricultural lands might be exposed to pesticides through non-occupational pathways including spray drift and volatilization of pesticides beyond the treated area. Objective - This review aimed to identify and analyze scientific literature measuring pesticide exposure in non-farmworker residents living close to agricultural lands, and to suggest practical implications and needs for future studies. Methods - A review was performed using inclusion criteria to identify original articles of interest published between 2003 and 2018. Results - From the 29 articles selected in this review, 2 belonged to the same study and were grouped, resulting in a total of 27 studies. Seven studies assessed exposure to pesticides using environmental samples, 13 collected biological samples and 7 analyzed both. Nine studies included a reference group of residents living far from agricultural lands while 11 assessed the influence of the spraying season or spray events on pesticide exposures. Studies included in this review provide evidence that residents living near to agricultural lands are exposed to higher levels of pesticides than residents living further away. Discussion and conclusion - This review highlights that the following study design characteristics may be more appropriate than others to measure pesticide spray drift exposure in non-farmworker residents living close to agricultural lands: inclusion of a non-agricultural control group, collection of both biological and environmental samples with repeated sampling, measurements at different periods of the year, selection of numerous study sites related to one specific crop group, and measurements of pesticides which are specific to agricultural use. However, few studies to date incorporate all these characteristics. Additional studies are needed to comprehensively measure non-occupational pesticide exposures in this population in order to evaluate health risks, and to develop appropriate prevention strategies.

This assessment was conducted by a multidisciplinary task force of experts, “Emergency Collective Expertise Group—Impact of the COVID-19 pandemic and lockdown on dengue surveillance and vector control interventions” of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES).; International audience; The concurrent circulation of dengue and coronavirus disease 2019 (COVID-19) may produce many unfavourable outcomes-such as co-infections; delays in diagnosis, treatment, and mitigation measures; overwhelming of the healthcare system; underreporting of cases; deterioration in surveillance and control interventions; and exacerbation of social inequalities. Indeed, lockdown is greatly compromising the effectiveness of vector control, especially social mobilization campaigns and preventive insecticide spraying in private spaces (indoor and peridomestic spraying). Thus, failure to appropriately implement the full range of vector control interventions can lead to a reduction in their overall effectiveness and an increasing risk of vector-borne diseases circulating. Consequently, the health community and policy makers should develop proactive policies and allocate adequate resources to prevent and manage the resurgence of dengue and other vector-borne diseases in the new era of COVID-19.

ObjectivesLarge amounts of mineral dust are transported from their African sources in the Saharan-Sahel region to the Caribbean Sea, generating peak exposures to particulate matter ≤10 µm (PM10). This study aimed to investigate the impact of Saharan dust episodes on preterm births in the Guadeloupe archipelago.MethodsThe study population consisted of 909 pregnant women who were enrolled in the TIMOUN mother-child cohort between 2004 and 2007. Desert dust episodes were assessed from PM10 concentrations recorded at the unique background air quality monitoring station located in Pointe-à-Pitre. For each woman, the daily PM10 concentrations were averaged over the entire pregnancy, and the proportion of days with intense dust episodes (≥55 µg PM10/m3) during pregnancy was calculated. Weighted logistic regression models adjusting for known individual sociomedical risk factors were used to estimate ORs and 95% CIs for preterm birth.ResultsDuring pregnancy, the mean PM10 concentrations ranged from 13.17 to 34.92 µg/m3, whereas the proportion of intense dust events ranged from 0.00% to 19.41%. Increased adjusted ORs were found for both the mean PM10 concentrations and the proportion of intense dust events (OR 1.40, 95% CI 1.08 to 1.81, and OR 1.54, 95% CI 1.21 to 1.98 per SD change, respectively). Restriction to spontaneous preterm births produced similar ORs but with wider 95% CIs.ConclusionConsidering the personal and social burden of this adverse pregnancy outcome, this finding is of importance for both healthcare workers and policy makers to provide necessary preventive measures.

International audience; Hair incorporates chemical compounds from the bloodstream and external sources as it grows. Different analytical procedures are proposed, but no consensus can be found for external contamination removal (washing stage). Thus, a major limitation of the use of hair analysis for human biomonitoring is the issue related to the washing efficiency, and the objective of this study was to propose a simple washing method for a better cleaning of external contamination. Based on a sequence of three steps of detergent or acid washing (Triton, nitric acid, and hydrochloric acid), the TNCl method was tested on raw and spiked samples and compared to other methods. Thirty-seven inorganic elements were analyzed by inductively Coupled Plasma Mass Spectrometry (ICP-MS) after washing and acid digestion of 10 hair samples (Li, Be, Na, Mg, Al, P, K, Ca, V, Cr, Fe, Mn, Co, N, Cu, Zn, As, Se, Sr, Mo, Ru, Ag, Cd, Sn, Sb, Cs, Ba, La, Ce, Nd, Gd, Lu, Tl, Pb, Bi, Th, and U). The inorganic element concentrations in the hair samples were compared to those reported in the literature. The TNCl method was shown to be more efficient than other methods based on the use of surfactants and organic solvents.

(1994). Social perception of aids in french general public: 1987–1990 Evolution in paris region. Psychology & Health: Vol. 9, No. 4, pp. 285-296.

Epidemiologic studies are crucial to the estimation of numbers of deaths attributable to air pollution. In this paper, the authors present a framework for distinguishing estimates of attributable cases based on time-series studies from those based on cohort studies, the latter being 5-10 times larger. The authors distinguish four categories of death associated with air pollution: A) air pollution increases both the risk of underlying diseases leading to frailty and the short term risk of death among the frail; B) air pollution increases the risk of chronic diseases leading to frailty but is unrelated to timing of death; C) air pollution is unrelated to risk of chronic diseases but short term exposure increases mortality among persons who are frail; and D) neither underlying chronic disease nor the event of death is related to air pollution exposure. Time-series approaches capture deaths from categories A and C, whereas cohort studies assess cases from categories A, B, and C. In addition, years of life lost can only be derived from cohort studies, where time to death is the outcome, while in time-series studies, death is a once-only event (no dimension in time). The authors conclude that time-series analyses underestimate cases of death attributable to air pollution and that assessment of the impact of air pollution on mortality should be based on cohort studies.

International audience; Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014-15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region ( = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.

International audience; BACKGROUND: Dengue fever is the most important arboviral infection that affects humans, particularly in tropical and subtropical regions. Here, we provide the first comprehensive overview of the severity of dengue epidemics in French Guiana. METHODOLOGY/PRINCIPAL FINDINGS: We monitored hospitalized cases between 2008 and 2013. Detailed clinical features and biological parameters were collected on a daily basis from all cases. Among the 1,356 cases, 216 (16%) were classified according to the WHO 2009 classification as dengue without warning signs (WS), 926 (68%) were classified as dengue with WS and 214 (16%) were classified as severe dengue. The severity rates were similar between the three major epidemics that occurred during the study period, whereas the hospitalization rate was highest in 2013. Fluid accumulation, aspartate aminotransferase (ASAT) counts>193 IU/L and platelet counts

Background During the last decade, French Guiana has been affected by major dengue fever outbreaks. Although this arbovirus has been a focus of many awareness campaigns, very little information is available about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. During the first outbreak of the chikungunya virus, a quantitative survey was conducted among high school students to study experiences, practices and perceptions related to mosquito-borne diseases and to identify socio-demographic, cognitive and environmental factors that could be associated with the engagement in protective behaviors. Methodology/Principal Findings A cross-sectional survey was administered in May 2014, with a total of 1462 students interviewed. Classrooms were randomly selected using a two-stage selection procedure with cluster samples. A multiple correspondence analysis (MCA) associated with a hierarchical cluster analysis and with an ordinal logistic regression was performed. Chikungunya was less understood and perceived as a more dreadful disease than dengue fever. The analysis identified three groups of individual protection levels against mosquito-borne diseases: “low” (30%), “moderate” (42%) and “high” (28%)”. Protective health behaviors were found to be performed more frequently among students who were female, had a parent with a higher educational status, lived in an individual house, and had a better understanding of the disease. Conclusions/Significance This study allowed us to estimate the level of protective practices against vector-borne diseases among students after the emergence of a new arbovirus. These results revealed that the adoption of protective behaviors is a multi-factorial process that depends on both sociocultural and cognitive factors. These findings may help public health authorities to strengthen communication and outreach strategies, thereby increasing the adoption of protective health behaviors, particularly in high-risk populations., Author Summary Although dengue fever has been a focus of many awareness campaigns in Latin America, very little information is available about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. At the initial onset of the first chikungunya outbreak, a quantitative survey was conducted among 1462 high school students aiming to study experiences, practices and perceptions related to mosquito-borne diseases and to identify factors that could be associated with protective behaviors. Chikungunya was less understood and perceived as a more dreadful disease than dengue fever. Students were clustered in three different groups according to their level of protection: “low” (30%), “moderate” (42%) and “high” (28%). Protective health behaviors were found to be performed more frequently among students who were female, lived with a parent who had a higher educational status, lived in an individual house, and had a better understanding of the disease. The results revealed that the adoption of protective behaviors is a multi-factorial process that depends on both socio-economic and cognitive factors. These findings may help the public health authorities to strengthen their communication and outreach strategy, thereby increasing the adoption of protective health behaviors, particularly in endemic countries and high-risk populations.

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., Author Summary Climatic determinants are amongst the most frequently cited in studies aimed at understanding and explaining the dynamics of vector-borne infections, and dengue in particular. French Guiana, a French overseas territory in which the vector Aedes aegypti is well established, experiences an epidemic cycle of dengue with large and prolonged epidemics occurring approximately every 3 years. Dengue is one of the most prioritized infectious diseases, and it requires an intense mobilization of local public health authorities, health services, and health professional and vector control services. A specific surveillance, preparedness and response plan has been developed based upon these needs. Gaining an accurate understanding of the drivers of dengue transmission is required to develop a model to predict the risk of an epidemic and to plan activities aimed at controlling it. Here, we assessed the effects of climatic factors on dengue spread to develop a predictive model of the epidemics in French Guiana on a country-wide scale. The goal of the model is to anticipate and plan both preventive and control activities. Given climate conditions, the model predicts that a dengue epidemic is likely to occur in early 2016. These conditions, which are favorable for Aedes mosquito proliferation, could also enhance the diffusion of other arboviruses, such as the Zika virus, in northeastern South America.

OBJECTIVE: To develop a criterion for early detection of bronchiolitis epidemics in Guadeloupe so that prevention and control strategies can be implemented in a more timely manner. METHODS: Weekly figures of bronchiolitis cases reported from July 2005-July 2010 by Guadeloupe's sentinel network were used. The criterion for detecting epidemics was created with data from the 2005-2009 bronchiolitis seasons. First, the baseline level for bronchiolitis (BL) was predicted by fitting a periodic regression on the non-epidemic observations; then a test was conducted of nine possible criteria to define epidemics by combining a statistical threshold set at different levels and a number of consecutive weeks with observations above and below them; lastly, the optimal criterion was selected considering its performances using expert advice as the gold standard. The selected criterion was validated with data from 2009-2010 season. RESULTS: The BL accounted for a linear trend and two sinusoidal functions of 52 and 26 weeks (R2 = 45%). According to the epidemic criterion selected, the statistical threshold was set at the upper limit of the one-sided 95% Confidence Interval of the predicted BL; 2 consecutive weeks with cases above it were necessary to set the start of an epidemic, and three again below to set the end. The median delay in launching the alerts was 2 weeks; there was one false alert; and the sensitivity, specificity, and positive predictive value for detecting epidemic weeks were 98%, 96%, 95%, respectively. During the validation period, the criterion launched one false alert and detected the epidemic with 4 weeks of delay. CONCLUSIONS: This criterion supports epidemiologists in timely interpretation of bronchiolitis epidemiological data for decision makers in Guadeloupe. In the future, it should be updated in accordance with trends in bronchiolitis epidemiology, and improved by integrating virological indicators. Its inclusion in an integrated management strategy for bronchiolitis prevention and control, supported by a bronchiolitis public health network, should also be encouraged.OBJETIVO: Formular un criterio para la detección temprana de las epidemias de bronquiolitis en Guadalupe, a fin de aplicar de manera más oportuna mejores estrategias de prevención y control. MÉTODOS: Se usaron las cifras semanales de los casos de bronquiolitis notificados desde julio del 2005 hasta julio del 2010 por la red de vigilancia de Guadalupe. El criterio para detectar las epidemias se estableció con los datos de las temporadas de bronquiolitis del 2005 al 2009. En primer lugar, se predijo el nivel basal de bronquiolitis ajustando una regresión periódica a los casos observados fuera de las epidemias; luego se pusieron a prueba nueve posibles criterios para definir las epidemias combinando un umbral estadístico establecido a diferentes niveles y un número de semanas consecutivas con las observaciones ubicadas por encima y por debajo de ellos; por último, se seleccionó el criterio óptimo conforme a su desempeño, usando el asesoramiento de expertos como criterio de referencia. El criterio seleccionado se validó con los datos de la temporada 2009-2010. RESULTADOS: El nivel basal de bronquiolitis presentaba una tendencia lineal y dos funciones sinusoidales de 52 y 26 semanas (R2 = 45%). Según el criterio de epidemia seleccionado, se fijó el umbral estadístico en el límite superior del intervalo de confianza de 95% unilateral del nivel basal de bronquiolitis previsto; para establecer el comienzo de una epidemia se requerían 2 semanas consecutivas con casos por encima de él, y 3 semanas con casos por debajo para determinar su finalización. La mediana del retraso para lanzar las alertas fue 2 semanas; hubo una alerta falsa; y la sensibilidad, la especificidad y el valor predictivo positivo para detectar las semanas de epidemia fueron 98%, 96% y 95%, respectivamente. Durante el período de validación se emitió, según el criterio, una alerta falsa y se detectó la epidemia con 4 semanas de retraso. CONCLUSIONES: Este criterio ayuda a los epidemiólogos a interpretar de manera oportuna los datos epidemiológicos de bronquiolitis a fin de tomar decisiones en Guadalupe. En el futuro, debe actualizarse según las tendencias en la epidemiología de la bronquiolitis, y mejorarse mediante su integración con indicadores virológicos. También debe promoverse su inclusión en una estrategia integrada de manejo para la prevención y el control de la bronquiolitis, apoyada por una red de salud pública relacionada con la bronquiolitis.

International audience; To strengthen active dengue surveillance in Saint Martin and Saint Barthélemy, two French Caribbean islands, we evaluated the epidemiological usefulness of collecting blood samples from NS1-positive dengue patients on filter paper to identify the dengue serotypes circulating in these regions during a 27-month period. This approach allowed dengue serotypes to be identified by reverse transcriptase-polymerase chain reaction in 90.1% of the total set of 666 samples analyzed and, in 95.5% of the samples collected during the acute phase of the disease. This prospective virological surveillance using blood samples absorbed onto filter paper, which were stored at 4°C and shipped at ambient temperature to a specialized laboratory for analysis, allowed us to avoid the logistic and financial costs associated with shipping frozen venous blood samples. This surveillance system offers a low-cost alternative for reinforcing dengue prevention in areas where specialized laboratories do not exist, notably by facilitating the early detection of potentially new dengue serotypes.

Background Sentinel general practitioner networks monitor influenza-like infections (ILI) in Martinique and in Guadeloupe (French West Indies). During the A(H1N1)2009 pandemic, they gave an ILI incidence estimation higher in Martinique than in Guadeloupe. In October 2009, a telephonic survey was launched in both islands to assess the number of ILI diagnoses performed by general practitioners since the beginning of the pandemic. This paper compares the results of sentinel surveillance, of telephonic survey and of hospital surveillance in Guadeloupe and in Martinique. Methods On each island, the sentinel network gathers a representative sample of voluntary general practitioners. Each week, they report the number of ILI they diagnosed the past week. Times series of these weekly numbers were modelized using the Serfling method with the upper limit of the confidence interval of the expected value representing the epidemic threshold. The telephone survey was conducted from October 2, 2009 to October 12, 2009 in Martinique and from October 13, 2009 to October 21, 2009 in Guadeloupe. The quota method was used for sampling individuals older than 14 years, leading to 507 interviews in Guadeloupe and 508 in Martinique. Results The epidemic lasted 12 weeks in both islands, from August 3 to October 25 in Martinique and from August 17 to November 8 in Guadeloupe. During August and September, estimated attack rate in Martinique was 5.52% (CI95: 5.23–5.83) from the sentinel network versus 8.3% (CI95: 6.0–11.0) from the telephone survey. In Guadeloupe, it was 2.13% (CI95: 1.97–2.24) from the sentinel network versus 6.9% (CI95: 4.8–9.5) from the telephone survey. An equivalent number of confirmed hospitalized cases was observed in the two islands. Conclusion These results suggest that the sentinel network underestimates ILI incidence in Guadeloupe. According to Emergency Room activity for ILI, it seems possible that ILI incidence was actually higher in Martinique. A lower proportion of swab sampling among ILI hospitalized people could partly explain the observed differences in hospitalization ratio, in severity and in lethality between the two islands.

Malaria, which was eliminated first from Metropolitan France (mainland and Corsica), then in the French West Indies and the Reunion Island during the 20(th) century, remains endemic in two French territories: French Guiana and the Indian Ocean Mayotte island. Despite differences in the dominating plasmodial species and epidemiological patterns, these two territories have achieved marked quantitative improvements (in the reported number of cases and severe cases) thanks to efforts undertaken over the past decade. The situation, however, remains a concern from a qualitative standpoint with the emergence of resistance to antimalarial drugs and logistical and administrative issues which hinder access to treatment. Although malaria was eradicated in Metropolitan France half a century ago, competent vectors remain present in part or all of these territories and can give rise to limited outbreaks.

Les regions de Guadeloupe, de Guyane et de la Martinique et les collectivites de Saint-Martin et Saint-Barthelemy ont deploye au niveau local un dispositif specifique pour surveiller l’emergence de la grippe A(H1N1) 2009. Apres une phase de confinement basee sur la detection et la gestion individuelle des cas, une surveillance a ete mise en place a l’echelle populationnelle, essentiellement basee sur les donnees des reseaux de medecins sentinelles et les confirmations virologiques. Tout comme l’ensemble des pays de la zone caraibe, les cinq territoires ont subi une epidemie liee au virus A(H1N1) 2009 ayant debute entre aout et septembre 2009. Malgre une dynamique similaire, ces vagues epidemiques ont presente des specificites en termes d’ampleur et de severite, avec un taux d’attaque variant de 28 a 70 pour 1 000 habitants et un taux d’hospitalisation de 4,3 a 10,3 pour 1 000 cas. Les outils de surveillance mis en place ont permis d’obtenir une vision globale et precise des caracteristiques de l’epidemie et semblent donc tout a fait adequats pour surveiller une eventuelle nouvelle vague epidemique. Certaines difficultes liees au contexte geographique ou sanitaire specifique des territoires concernes (complexite de l’acheminement des prelevements pour la surveillance virologique, survenue concomitante d’epidemies de dengue) sont apparues, et a l’inverse certaines specificites locales (presence de comites d’experts et de reseaux actifs de medecins sentinelles) ont facilite la surveillance et la gestion de l’episode.

Background Key symptoms observed during the febrile phase of dengue may identify patients who are likely to progress to severe disease. Objectives To test this hypothesis, we examined the relationships between symptoms reported by patients at presentation and the development of severe outcomes. Study design Retrospective analysis of data recorded prospectively in 560 adult dengue patients admitted to an emergency department. A logistic regression analysis was used to quantify the association between symptoms reported at presentation and outcome. Results Plasma leakage was observed in 95 patients (17%), severe thrombocytopenia (platelet counts 9 /L) in 93 patients (16.6%) and acute hepatitis in 42 patients (7.5%). Severe thrombocytopenia developed in 57% of patients with plasma leakage and 40.5% of patients with hepatitis. Patients who developed a plasma leakage syndrome were older, mainly male, and reported more often an abdominal pain and a cough. Diarrhea and taking paracetamol >60 mg/kg/day before admission were associated with the development of acute hepatitis. Seven patients died. The mortality rate was 6/95 (6.3%) in patients who developed plasma leakage, 3/42 (7.1%) in patients who developed hepatitis, 5/93 (5.4%) in patients with severe thrombocytopenia, and 3/12 (25%) in the patients who demonstrated together all these severe manifestations. Conclusion Plasma leakage, severe thrombocytopenia and acute hepatitis identified subgroups of adult dengue patients with increased mortality rates. Key symptoms reported by the patients at presentation such as abdominal pain, cough or diarrhea were significantly associated with the development of severe manifestations and should be considered as warning signs.

Introduction: Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France. Objectives: We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013. Methods: The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10–2.5, PM2.5, NO2, O3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations. Results: The cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM2.5, PM10-25, NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 μg/m3, PM10-25; HR = 1.09;95% CI: 1.04, 1.15 per 2.2 μg/m3, NO2: HR = 1.14; 95% CI: 0.99, 1.31 per 19.3 μg/m3 and benzene: HR = 1.10; 95% CI: 1.00, 1.22 per 1.7 μg/m3).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 μg/m3. PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality. Conclusion: Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample. Keywords: Air pollution, Mortality, Cohort study, Epidemiology, France

Contexte En octobre 1995, une cinquantaine de cas d’appendicite aigue survenus au sein de la population de l’ile de la Desirade (1 605 residants) sont signales a la DDASS par l’unique medecin de l’ile. Nous presentons l’ensemble des investigations qui ont ete menees afin de decrire ce phenomene et generer des hypotheses quant a son origine. Methodes Une recherche exhaustive des cas d’appendicectomies survenus entre le 10 aout 1995 et le 22 juillet 1996 au sein de la population a ete realisee. Nous avons etudie l’ensemble des dossiers d’hospitalisation disponibles, expertise les lames d’appendicectomies, interviewe les cas et leurs familles afin de reconstituer les histoires cliniques individuelles et familiales, etudie la prevalence du portage infectieux et parasitaire au sein de la population, et etudie la qualite de l’eau du reseau de distribution. Resultats Deux cent vingt-six cas d’appendicectomies ont ete identifies (14,1 % de la population de l’ile) ; 40 % au cours de la periode mai-juin 1996 ; 46 % chez les hommes et 40 % chez les enfants âges de moins de 15 ans. Les donnees cliniques, biologiques et anatomopathologiques ne sont pas en faveur de l’existence d’une epidemie d’appendicites aigues ou de syndromes appendiculaires aigus. Les enquetes epidemiologiques menees aupres des cas et de leur famille ne permettent pas d’evoquer un phenomene de toxi-infection collective ou d’infection a transmission inter-humaine. Cependant, elles revelent l’existence frequente de symptomes douloureux abdominaux non specifiques, d’allure subaigue ou chronique. Les examens de selles realises dans la population ne montrent pas d’infestation parasitaire, ni de contamination bacterienne anormalement frequentes. Les resultats du controle sanitaire de l’eau de distribution sont conformes a la reglementation et les analyses specifiques effectuees ne montrent pas de contamination chimique de l’eau. Conclusions L’ensemble des investigations menees n’a pas permis d’identifier une cause unique d’origine infectieuse ou toxique a l’origine d’une prevalence elevee de troubles abdominaux chroniques au sein d’une population isolee. Dans ce contexte insulaire, une reponse medico-chirurgicale inappropriee a sans doute ete a l’origine de cette epidemie d’appendicectomies aux consequences non negligeables en termes de sante publique.

International audience; We performed a geographical analysis of cancer mortality in the communes surrounding an industrial mining complex (Salsigne, France) where suspicious levels of pollution due to arsenic were measured. Compared with that observed in a control area, we showed a significant excess of mortality due to all cancer types (ratio of standard mortality ratios (ratio of SMRs)=1.1), lung cancer (ratio of SMRs=1.8), pharynx cancer (ratio of SMRs=2.1) in the whole population, and due to digestive system cancer (ratio of SMRs=1.3) among women. The results were similar after controlling for the occupation distribution in the populations. Excluding mining complex workers deaths from the deaths in the studied populations did not modify the pattern of our results. We concluded that the excess of cancer deaths could not be exclusively due to potential professional exposures among the workers of the mining complex and are probably explained by environmental contamination.

Air pollution is associated with total mortality. This association may be confounded by uncontrolled time-varying risk factors such as influenza epidemics.We analyzed independent data on influenza epidemics from 7 European cities that also had data on mortality associated with particulates (PM10). We used 10 methods to control for epidemics (5 derived from influenza data and 5 from respiratory mortality series) and compared those results with analyses that did not control for these epidemics.Adjustment for influenza epidemics increased the PM10 effect estimate in most cases (% change in the pooled regression coefficient: -1.9 to 38.9 for total mortality and 1.3 to 25.5 for cardiovascular mortality). A 10-microg/m increase in PM10 concentrations (lag 0-1) was associated with a 0.48% (95% confidence interval=0.27-0.70%) increase in daily mortality unadjusted for influenza epidemics, whereas under the various methods to control for epidemics the increase ranged from 0.45% (0.26-0.69%) to 0.67% (0.46-0.89%). The corresponding figures for cardiovascular mortality were 0.85% (0.53-1.18%) with no adjustment and from 0.86% (0.53-1.19%) to 1.06% (0.74-1.39%) with the methods of control.The association between air pollution and mortality is not weakened by control for influenza epidemic irrespective of the method used. To adjust for influenza epidemics, one can use methods based on respiratory mortality counts instead of counts of influenza cases if the latter are not available. However, adjustment for influenza by any method tested did not markedly alter the air pollution effect estimate.

Resume Objectif Quantifier les effets a court terme de la pollution atmospherique sur la mortalite et les admissions hospitalieres d’origine cardio-vasculaire ou respiratoire, dans les 9 villes (Bordeaux, Le Havre, Lille, Lyon, Marseille, Paris, Rouen, Strasbourg et Toulouse) du Programme de Surveillance Air et Sante. Methodes Les donnees de mortalite et d’hospitalisation etaient disponibles, respectivement, de 1990 a 1997 et de 1995 a 1999. Les donnees d’exposition concernaient les concentrations du dioxyde de soufre, des particules de diametre inferieur ou egal a 10 mm, des fumees noires, du dioxyde d’azote, de l’ozone, du monoxyde de carbone. L’analyse a mis en relation, dans chacune des villes, les nombres journaliers de deces et d’hospitalisations avec les niveaux journaliers des polluants, en tenant compte d’un ensemble de facteurs de confusion. Un risque relatif combine a ete calcule pour l’ensemble des villes. Les nombres de deces et d’hospitalisations attribuables a la pollution atmospherique dans chacune des villes ont ete estimes a partir de ce risque relatif. Resultats Des associations significatives ont ete observees pour la mortalite, quelle que soit la cause, et pour les hospitalisations pour motifs respiratoires chez les moins de 15 ans. Si les niveaux de pollution atmospherique etaient ramenes a 10 μg/m3 sur les 9 villes, 2800 deces anticipes au total et 750 hospitalisations respiratoires chez les enfants seraient evitables chaque annee. Conclusion Il est possible d’estimer l’impact de la reduction de la pollution sur la sante pour le court terme. Ces analyses permettent de donner une dimension sanitaire aux politiques de reduction de la pollution urbaine au niveau local et europeen.

Resume L'etude propose un mode d'evaluation de la morbidite liee aux pollens a partir des donnees de consommation medicamenteuse issues du codage du medicament. Les donnees concernent la population du regime general du departement du Puy-de-Dome. Un suivi hebdomadaire des consommants a ete realise depuis le 1 er janvier 1999 jusqu'au 31 decembre 2001, en prenant en compte la date de delivrance du medicament. Trois groupes de medicaments ont ete etudies : les anti-allergiques, les antibiotiques et les antidiabetiques. Les resultats montrent la presence d'un important pic saisonnier au printemps. Un mode de quantification est propose pour estimer a minima le nombre de personnes concernees par les manifestations allergiques polliniques au printemps (2,2 % de la population). Les donnees suggerent la presence d'autres pics de consommation medicamenteuse lies aux pollens en dehors de la periode de mai–juin. L'etude met en avant le probleme represente par les prescriptions non appropriees d'antibiotiques qui conduirait, si on ne prend pas en compte ces prescriptions, a une sous-evaluation probable de la morbidite liee aux pollens. Un suivi temporel au long cours de ces donnees devrait permettre d'apprecier s'il y a ou non, augmentation de la prevalence des phenomenes allergiques lies aux pollens.

Background Leptospirosis is a neglected zoonosis affecting mainly tropical and subtropical regions worldwide, particularly South America and the Caribbean. As in many other countries, under-reporting of cases was suspected in the French West Indies because of inadequate access to diagnostic tests for the general population. Methodology/Principal findings In order to estimate the real incidence of leptospirosis in Guadeloupe and Martinique, a study was performed in 2011 using the three prevailing available biological tests for diagnosis: Microscopic Agglutination Test (MAT), IgM ELISA and PCR. The study investigated inpatients and outpatients and used active case ascertainment from data provided by a general practitioners’ sentinel network. The epidemiology of the disease was also described in terms of severity and demographic characteristics. Leptospirosis incidence was estimated at 69.4 (95%CI 47.6–91.1) and 60.6 (95%CI 36.3–85.0) annual cases per 100 000 inhabitants in Guadeloupe and Martinique, respectively, which was 3 and 4 times higher than previous estimations. Conclusion/Significance Inclusion of PCR and IgM ELISA tests for diagnosis of leptospirosis resulted in improved sensitivity in comparison with MAT alone. Our results highlighted the substantial health burden of the disease in these two territories and the importance of access to appropriate laboratory tests. Based on our results, PCR and IgM ELISA tests have now been included in the list of tests reimbursed by the national system of social security insurance in France. Our results also underline the relevance of implementing an integrated strategy for the surveillance, prevention and control of leptospirosis in the French West Indies., Author Summary Leptospirosis is a common disease in tropical regions around the world. It is caused by a bacteria excreted in environmental waters by mammals, especially rodents, through their urine. Leptospirosis has symptoms similar to other tropical diseases, including dengue fever, and early laboratory diagnosis is crucial to provide both appropriate treatments for patients and rapid control measures when an outbreak occurs. In 2011, we undertook a study to determine the incidence of leptospirosis in two territories (Guadeloupe and Martinique) in the French West Indies by establishing a surveillance network and implementing new diagnostic assays in order to ensure an exhaustive diagnostic analysis. We concluded that leptospirosis was previously significantly under-reported in the French West Indies and we recommended: 1- access to these new diagnostic tests for the entire population for a better detection of leptospirosis patients and, 2- the implementation of an integrated surveillance, alert and prevention system for the disease in this region. Our findings had raised the awareness of this neglected disease in the French West Indies and, as another consequence; new diagnostic tests are now reimbursed by the social security insurance in France.

Introduction Les effets a long terme de la pollution atmospherique (PA) sur la mortalite ont ete demontres dans de nombreux pays. En France, ces donnees sont peu frequentes. Objectif L’objectif de l’etude etait d’evaluer le lien entre 25 ans d’exposition a la PA et le risque de mortalite toutes causes non accidentelles et pour causes cardiovasculaires et respiratoires a partir des donnees de la cohorte francaise Gazel. Materiel et methodes L’echantillon de l’etude etait compose de 20 327 adultes volontaires travailleurs d’EDF-GDF suivis de 1989 a 2013. L’exposition annuelle aux PM 10 , PM 2,5 , NO 2 , O 3 , SO 2 et benzene a ete evaluee au lieu de residence des participants en utilisant un modele de chimie transport en prenant en compte le calendrier residentiel. Les exces de risques, exprimes en hazard ratio (HR), ont ete estimes a l’aide d’un modele de regression a risques proportionnels de Cox en ajustant sur les facteurs de confusion potentiels individuels et contextuels. Les HR ont ete calcules pour une augmentation de l’intervalle interquartile de la distribution des concentrations des polluants. Resultats Le nombre de deces survenus en fin de periode etait de 1967 (9,7 %) pour la mortalite toutes causes non accidentelles, 165 (0,8 %) pour causes cardiovasculaires et 284 (1,4 %) pour causes respiratoires. Une exposition a long terme aux PM 2,5 , PM 10–25 , NO 2 et benzene etait associee a une augmentation de la mortalite non accidentelle lorsque l’exposition etait prise en compte a l’inclusion. Pour les PM 2,5 , le HR etait de 1,09 (intervalle de confiance [IC] 95 % : 0,99–1,20) pour une augmentation de 5,9 μg/m 3 ; pour les PM 10−25 , HR = 1,09 (IC 95 % : 1,04–1,15) pour une augmentation de 2,2 μg/m 3 ; pour le NO 2 , HR = 1,14 (IC 95 % : 0,99–1,31) pour une augmentation de 19,3 μg/m 3 ; et pour le benzene, HR = 1,10 (IC a 95 % : 1,00–1,22) pour une augmentation de 1,7 μg/m 3 . L’association la plus forte etait observee pour les PM 10 , HR = 1,14 (IC 95 % : 1,05–1,25) pour une augmentation de 7,8 μg/m 3 . Aucune association n’a ete observee entre l’exposition a long terme a la PA et la mortalite cardiovasculaire et respiratoire. Conclusion Une exposition a long terme aux particules fines, dioxyde d’azote, dioxyde de soufre et benzene est associee a un risque accru de mortalite non accidentelle en France. Nos resultats sont concordants avec les donnees existantes de la litterature et confirment que la pollution de l’air exterieur est un important facteur de risque environnemental de mortalite.

International audience; Dengue is a public health concern across the globe, and an escalating problem in the Americas. As part of a wider programme (covering Latin America and South East Asia) to characterize the epidemiology of dengue in dengue endemic areas, we undertook a systematic literature review to assess epidemiological trends (incidence, timing and duration of outbreaks/epidemics, age and sex distribution, serotype distribution, seroprevalence and disease severity) for dengue across the French Territories of the Americas (FTA), in French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy between 2000 and 2012 (CRD42012002341: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002341). Of 413 relevant data sources identified, 45 were eligible for inclusion. A large proportion of the available data were from national surveillance reports, and 12 publications were from peer-reviewed journals. During the review period, 3-5 epidemics were identified in each of the island territories and French Guiana, and epidemics were often associated with a shift in the predominant circulating dengue virus serotype. Substantial gaps in epidemiological knowledge were identified. In particular, information regarding dengue virus genotype distribution, seroprevalence and age distribution of dengue were lacking. Additionally, much of the available data were from epidemic years; data from inter-epidemic periods were sparse. Nevertheless, the available epidemiological data showed that dengue is endemic across the FTA and suggest an evolution towards hyperendemicity, highlighting the need to continue the efforts with the existing surveillance programmes to assist in planning an effective vaccination programme once a dengue vaccine is deployed.

International audience

Dengue is a public health concern across the globe, and an escalating problem in the Americas. As part of a wider programme (covering Latin America and South East Asia) to characterize the epidemiology of dengue in dengue endemic areas, we undertook a systematic literature review to assess epidemiological trends (incidence, timing and duration of outbreaks/epidemics, age and sex distribution, serotype distribution, seroprevalence and disease severity) for dengue across the French Territories of the Americas (FTA), in French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy between 2000 and 2012 (CRD42012002341: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002341). Of 413 relevant data sources identified, 45 were eligible for inclusion. A large proportion of the available data were from national surveillance reports, and 12 publications were from peer-reviewed journals. During the review period, 3–5 epidemics were identified in each of the island territories and French Guiana, and epidemics were often associated with a shift in the predominant circulating dengue virus serotype. Substantial gaps in epidemiological knowledge were identified. In particular, information regarding dengue virus genotype distribution, seroprevalence and age distribution of dengue were lacking. Additionally, much of the available data were from epidemic years; data from inter-epidemic periods were sparse. Nevertheless, the available epidemiological data showed that dengue is endemic across the FTA and suggest an evolution towards hyperendemicity, highlighting the need to continue the efforts with the existing surveillance programmes to assist in planning an effective vaccination programme once a dengue vaccine is deployed. Protocol registration PROSPERO CRD42012002341, Author Summary Dengue disease is a mosquito-borne viral illness and is a major health concern in the Americas. We conducted a literature analysis and review to describe the epidemiology of dengue in the French Territories of the Americas (FTA), comprising French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy, to determine the impact of dengue on the population and to identify research priorities. We used well-defined methods to search for and identify relevant research conducted between 2000 and 2012. We identified an increase in the frequency, magnitude and severity of dengue epidemics across all the territories, an increase in the co-circulation of serotypes and the evolution to a hyperendemic state. Countries sharing geographical and environmental characteristics (e.g., Martinique and Guadeloupe, and Saint Barthélemy and Saint Martin) also shared characteristics in dengue epidemiology and its evolution, including timing of epidemics and circulating serotypes. Gaps in epidemiological knowledge provide several avenues for research, such as dengue virus genotype distribution, seroprevalence and age distribution of dengue cases. Epidemiological and virological surveillance of dengue in the FTA is evolving, and improved knowledge of the disease in these territories will improve anticipation of epidemics and aid implementation of control measures.

We applied sequential pattern extraction to identify the most important climatic factors related to dengue fever in French Guiana. Our findings suggest that the local climate has major effects on the occurrence of dengue epidemics in French Guiana and highlight the utility of the data mining approach to analyze disease surveillance data on a temporal and a spatial scale in relation to climatic, social and environmental variables. This study is a first step of a data mining project which will help to better understand and accurately predict temporal dynamics of dengue fever in French Guiana.

De nombreuses études épidémiologiques ont observé dans des contextes différents une faible relation à court terme entre les particules et la mortalité cardio-pulmonaire, même quand les normes de qualité de l'air n'étaient pas dépassées. La causalité de cette relation est un enjeu de santé publique en raison de l'importance de la population exposée. Notre objectif est de faire l'inventaire critique des arguments utilisés dans 15 revues de la littérature publiées. Nous expliquons l'importance de distinguer la validité de la causalité et analysons de façon systématique les différents critères de jugement dans le contexte des études écologiques temporelles. Notre conclusion est que la relation observée est valide et que la plupart des critères de causalité sont respectés. Diminuer le niveau d'exposition des populations aux particules est souhaitable. En Europe, en agissant à la source, notamment sur les émissions Diesel, on diminuera aussi d'autres polluants qui peuvent jouer un rôle sanitaire. Aux États-Unis, la situation est plus complexe car les particules sont surtout secondaires. Il est également indispensable de poursuivre les recherches pour mieux connaître les déterminants des expositions globales des individus et mieux comprendre le rôle toxique des différents facteurs physico-chimiques des particules.

A case-control study on respiratory cancers was conducted in New Caledonia (South Pacific), where a high incidence of malignant pleural mesothelioma had been observed. The disease pattern suggested an environmental exposure to asbestos. The first results showed that, in some areas, tremolite asbestos derived from local outcroppings was used as whitewash (locally named "pö"). All cases diagnosed between 1993 and 1995 (including 15 pleural mesotheliomas, 228 lung cancers, and 23 laryngeal cancers) and 305 controls were included in the study. Detailed information on past or present use of the whitewash, residential history, smoking, diet, and occupation was collected. The risk of mesothelioma was strongly associated with the use of the whitewash (odds ratio (OR) = 40.9; 95% confidence interval (CI): 5.15, 325). All Melanesian cases had been exposed. Among Melanesian women, exposure to the whitewash was associated with an increased risk of lung cancer (OR = 4.89; 95% CI: 1.13, 21.2), and smokers exposed to po had an approximately ninefold risk (OR = 9.26; 95% CI: 1.72, 49.7) compared with women who never smoked and had never used the whitewash. In contrast, no association was noted between exposure to pö and lung cancer risk among Melanesian men, probably because of lower exposure levels. Among non-Melanesians, the numbers of exposed subjects were too small to assess the effect of exposure to po. There was no indication of elevated risks for the other cancer sites.