Publications by authors named "Christophe Rapp"

62 Publications

[Dengue fever: an emerging infectious disease].

Authors:
Christophe Rapp

Rev Prat 2020 Mar;70(3):318-325

Hôpital américain de Paris, pôle médecine, Neuilly-sur-Seine, France.

Dengue fever: an emerging infectious disease. Dengue fever is caused by an arbovirus of the family Flaviviridae and the genus Flavivirus, of which there are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). It is transmitted by the bite of a diurnal mosquito of the genus Aedes, mainly A. aegypti and A. albopictus. An increasing cause of acute fever in travellers, it threatens to emerge in temperate regions where competent mosquitoes (Aedes) are established. Dengue fever is characterized by its clinical polymorphism ranging from asymptomatic to severe forms, which are rare in travellers. Its definite diagnosis is based on virological tests selected according to the stage of the disease and the kinetics of the virus. Its treatment is only symptomatic. It is a notifiable disease in mainland France and is subject to a plan to combat its spread and to specific surveillance in the overseas departments. Dengue prevention is based on the application of personal anti-vectorial protection measures among travellers, awareness-raising among health professionals and social mobilization to combat larval gites in endemic regions or regions colonized by Aedes. In France, the tetravalent vaccine Dengvaxia, which is licensed in France, is not recommended for people residing in overseas departments and for travelers to endemic areas.
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March 2020

Imported Plasmodium falciparum malaria following non-pharmaceutical forms of Artemisia annua prophylaxis.

J Travel Med 2019 Dec;26(8)

Service de maladies infectieuses et tropicales Hôpital Américain de Paris, 63 Bd Victor hugo, 92020 Neuilly sur Seine, France; Service de maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94 160, Saint-Mandé, France.

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http://dx.doi.org/10.1093/jtm/taz073DOI Listing
December 2019

New filovirus disease classification and nomenclature.

Nat Rev Microbiol 2019 05;17(5):261-263

World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of the Congo.

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http://dx.doi.org/10.1038/s41579-019-0187-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637750PMC
May 2019

High heterogeneity in community-acquired pneumonia inclusion criteria: does this impact on the validity of the results of randomized controlled trials?

BMC Infect Dis 2018 Dec 3;18(1):607. Epub 2018 Dec 3.

Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

Background: There is no consensus on the most accurate combination of diagnostic criteria to define community acquired pneumonia (CAP). We describe inclusion criteria in randomized controlled trials (RCT) of CAP and assess their performance for the diagnosis of formally identified CAP.

Methods: RCTs related to CAP recorded on ClinicalTrials.gov were analysed. Due to high heterogeneity, we divided close CAP inclusion criteria into patterns (i.e. combinations of inclusion criteria). To assess their diagnostic performances, these CAP definition patterns were applied to a reference population of 319 suspected CAP patients, in whom the CAP diagnosis had been confirmed (n = 163) or excluded (n = 156) by an adjudication committee after a systematic thoracic CT-scan and a 28-day follow-up period.

Results: In the 47 RCTs included in the analysis, 42 different CAP inclusion criteria combinations were identified and 8 patterns created. This heterogeneity was not explained either by the trials' methodology or by their objectives. When applied to the reference population, the performance ranges of the 8 definition patterns were 9.8-56.4% for sensitivities, 56.4 97.4% for specificities, 63.6 83.6% for positive predictive values and 50.8-66.7% for negative predictive values. None of the CAP definitions had both sensitivity and specificity superior to 65%. Depending on the CAP definition, the rate of included patients without CAP ("false positives") ranged from 1 to 21%.

Conclusions: CAP diagnostic criteria within RCTs are heterogeneous, which may have far-reaching consequences on validity of RCT results.
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http://dx.doi.org/10.1186/s12879-018-3515-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276130PMC
December 2018

Morning blisters: cantharidin-related Meloidae burns.

J Travel Med 2018 07;25(1)

Infectious and Tropical Diseases Unit, Bégin Military Hospital, Saint-Mandé, France.

We report several cases of Meloidae-related blisters in French soldiers deployed to Mali. Blister beetles of the Meloidae family produce cantharidin, a blistering agent, for defensive purposes. These virtually cosmopolitan Coleoptera can cause significant nuisance to travellers and deployed soldiers especially during the rainy season in the Sahel region.
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http://dx.doi.org/10.1093/jtm/tay045DOI Listing
July 2018

Mind the eye-squirter! An Anthia sexmaculata sexmaculata-related necrotic burn.

J Travel Med 2018 01;25(1)

Infectious and Tropical Diseases unit, Bégin Military Hospital, Saint-Mandé, France.

We report the case of an Anthia sexmaculata sexmaculata-associated necrotic burn in a French expatriate in Mauritania. Anthia spp.-related injury is a common though underreported health issue in the Sahelo-Saharan area. Deployed soldiers and travellers should be aware of these beetles when adventuring in this region.
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http://dx.doi.org/10.1093/jtm/tay033DOI Listing
January 2018

Leptospirosis among Returned Travelers: A GeoSentinel Site Survey and Multicenter Analysis-1997-2016.

Am J Trop Med Hyg 2018 07 10;99(1):127-135. Epub 2018 May 10.

Center for Tropical Medicine and Travel Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands.

Leptospirosis is a potentially fatal emerging zoonosis with worldwide distribution and a broad range of clinical presentations and exposure risks. It typically affects vulnerable populations in (sub)tropical countries but is increasingly reported in travelers as well. Diagnostic methods are cumbersome and require further improvement. Here, we describe leptospirosis among travelers presenting to the GeoSentinel Global Surveillance Network. We performed a descriptive analysis of leptospirosis cases reported in GeoSentinel from January 1997 through December 2016. We included 180 travelers with leptospirosis (mostly male; 74%; mostly tourists; 81%). The most frequent region of infection was Southeast Asia (52%); the most common source countries were Thailand ( = 52), Costa Rica ( = 13), Indonesia, and Laos ( = 11 each). Fifty-nine percent were hospitalized; one fatality was reported. We also distributed a supplemental survey to GeoSentinel sites to assess clinical and diagnostic practices. Of 56 GeoSentinel sites, three-quarters responded to the survey. Leptospirosis was reported to have been most frequently considered in febrile travelers with hepatic and renal abnormalities and a history of freshwater exposure. Serology was the most commonly used diagnostic method, although convalescent samples were reported to have been collected infrequently. Within GeoSentinel, leptospirosis was diagnosed mostly among international tourists and caused serious illness. Clinical suspicion and diagnostic workup among surveyed GeoSentinel clinicians were mainly triggered by a classical presentation and exposure history, possibly resulting in underdiagnosis. Suboptimal usage of available diagnostic methods may have resulted in additional missed, or misdiagnosed, cases.
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http://dx.doi.org/10.4269/ajtmh.18-0020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085784PMC
July 2018

Prevalence and risk factors for Extended-Spectrum Beta-Lactamase-producing- Enterobacteriaceae in French military and civilian travelers: A cross-sectional analysis.

Travel Med Infect Dis 2018 May - Jun;23:44-48. Epub 2018 Mar 28.

Service de maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94 160, Saint-Mandé, France.

Background: International travel is a risk factor for colonization with Extended-Spectrum Beta-Lactamase-producing- Enterobacteriaceae (ESBL-E). We describe the prevalence of and risk-factors for ESBL-E colonization in civilian and military travelers.

Methods: Patients hospitalized in the infectious diseases department of Bégin Military Hospital (France) from May 2012 to November 2015, who had traveled abroad over the past two months, were screened for intestinal colonization with ESBL-E.

Results: Forty-one out of 166 travelers (24.7%) had ESBL-E colonization, predominantly Escherichia coli. The risk factors for ESBL-E colonization in the univariate analysis were a treatment with any antibiotic in the last two months (OR 4.19, 95% CI 1.91-9.16) or with a beta-lactam in the same period (OR 3.35, 95% CI 1.44-7.82), and an hospitalization in the last two months (OR 3.96, 95% CI 1.91-9.16). The military status, military mission or military accommodation were not associated with an increased risk of ESBL-E colonization. In the multivariate analysis, a treatment with any antibiotic in the last two months was significantly associated with ESBL-E colonization (OR 6.71, 95% CI 3.36-19.08).

Conclusion: Antibiotic treatment in the two previous months is strongly predictive of ESBL-E colonization in international travelers, while the military status and its specific living conditions are not.
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http://dx.doi.org/10.1016/j.tmaid.2018.03.009DOI Listing
October 2018

Thromboelastographic study of the snakebite-related coagulopathy in Djibouti.

Blood Coagul Fibrinolysis 2018 Mar;29(2):196-204

Centre de transfusion sanguine des armées, Clamart, France.

: Hemostasis disorders are one of the major clinical conditions of snakebites and are because of mechanisms which may disrupt vessels, platelets, clotting factors and fibrinolysis. Thromboelastography (TEG) could help to understand these effects in the clinical practice. A retrospective study reports a series of patients presenting a snakebite-related coagulopathy, treated with antivenom and monitored with conventional tests and TEG in a French military treatment facility (Republic of Djibouti, East Africa) between August 2011 and September 2013. Conventional coagulation assays (platelets, prothrombin time, activated partial thromboplastin time, fibrinogen) and TEG measurements were taken on arrival and at various times during the first 72 h of hospitalization, at the discretion of the physician. The study included 14 patients (median age 28 years). Bleedings were present in five patients. All patients received antivenom. A coagulopathy was present in all patients and was detected by both conventional assays and TEG. None exhibited thrombocytopenia. Prothrombin time and fibrinogen remained abnormal for most of patients during the first 72 h. The TEG profiles of 11 patients (79%) showed incoagulability at admission (R-time > 60 min). TEG distinguished 10 patients with a generalized clotting factor deficiency and 4 patients with an isolated fibrinogen deficiency after an initial profile of incoagulability. Hyperfibrinolysis was evident for 12 patients (86%) after Hour 6. Snake envenomations in Djibouti involve a consumption coagulopathy in conjunction with delayed hyperfibrinolysis. TEG could improve medical management of the condition and assessment of additional therapeutics associated with the antivenom.
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http://dx.doi.org/10.1097/MBC.0000000000000702DOI Listing
March 2018

Zika beyond the Americas: Travelers as sentinels of Zika virus transmission. A GeoSentinel analysis, 2012 to 2016.

PLoS One 2017 3;12(10):e0185689. Epub 2017 Oct 3.

Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.

Background: Zika virus (ZIKV) was first isolated in Africa; decades later, caused large outbreaks in the Pacific, and is considered endemic in Asia. We aim to describe ZIKV disease epidemiology outside the Americas, the importance of travelers as sentinels of disease transmission, and discrepancies in travel advisories from major international health organizations.

Methods And Findings: This descriptive analysis using GeoSentinel Surveillance Network records involves sixty-four travel and tropical medicine clinics in 29 countries. Ill returned travelers with a confirmed or probable diagnosis of ZIKV disease acquired in Africa, Asia and the Pacific seen between 1 January 2012 and 31 December 2016 are included, and the frequencies of demographic, trip, and diagnostic characteristics described. ZIKV was acquired in Asia (18), the Pacific (10) and Africa (1). For five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon), GeoSentinel patients were sentinel markers of recent Zika activity. Additionally, the first confirmed ZIKV infection acquired in Kiribati was reported to GeoSentinel (2015), and a probable case was reported from Timor Leste (April 2016), representing the only case known to date. Review of Zika situation updates from major international health authorities for country risk classifications shows heterogeneity in ZIKV country travel advisories.

Conclusions: Travelers are integral to the global spread of ZIKV, serving as sentinel markers of disease activity. Although GeoSentinel data are collected by specialized clinics and do not capture all imported cases, we show that surveillance of imported infections by returned travelers augments local surveillance system data regarding ZIKV epidemiology and can assist with risk categorization by international authorities. However, travel advisories are variable due to risk uncertainties.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185689PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626466PMC
October 2017

An uncommon triad.

J Travel Med 2017 09;24(5)

Department of Rheumatology, Bégin Military Hospital, Saint-Mandé, France.

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http://dx.doi.org/10.1093/jtm/tax047DOI Listing
September 2017

Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea.

Emerg Infect Dis 2017 08;23(8):1380-1383

We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014-2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred.
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http://dx.doi.org/10.3201/eid2308.161804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547773PMC
August 2017

[Prolonged fever and pain in the right upper quadrant].

Rev Prat 2017 02;67(2):167-171

Centre médical des entreprises travaillant à l'extérieur, Paris, France.

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February 2017

Arboviral and other illnesses in travellers returning from Brazil, June 2013 to May 2016: implications for the 2016 Olympic and Paralympic Games.

Euro Surveill 2016 Jul;21(27)

University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France.

We evaluated EuroTravNet (a GeoSentinel subnetwork) data from June 2013 to May 2016 on 508 ill travellers returning from Brazil, to inform a risk analysis for Europeans visiting the 2016 Olympic and Paralympic Games in Brazil. Few dengue fever cases (n = 3) and no cases of chikungunya were documented during the 2013-15 Brazilian winter months, August and September, the period when the Games will be held. The main diagnoses were dermatological (37%), gastrointestinal (30%), febrile systemic illness (29%) and respiratory (11%).
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http://dx.doi.org/10.2807/1560-7917.ES.2016.21.27.30278DOI Listing
July 2016

Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

Authors:
Daouda Sissoko Cedric Laouenan Elin Folkesson Abdoul-Bing M'Lebing Abdoul-Habib Beavogui Sylvain Baize Alseny-Modet Camara Piet Maes Susan Shepherd Christine Danel Sara Carazo Mamoudou N Conde Jean-Luc Gala Géraldine Colin Hélène Savini Joseph Akoi Bore Frederic Le Marcis Fara Raymond Koundouno Frédéric Petitjean Marie-Claire Lamah Sandra Diederich Alexis Tounkara Geertrui Poelart Emmanuel Berbain Jean-Michel Dindart Sophie Duraffour Annabelle Lefevre Tamba Leno Olivier Peyrouset Léonid Irenge N'Famara Bangoura Romain Palich Julia Hinzmann Annette Kraus Thierno Sadou Barry Sakoba Berette André Bongono Mohamed Seto Camara Valérie Chanfreau Munoz Lanciné Doumbouya Souley Harouna Patient Mumbere Kighoma Fara Roger Koundouno Réné Lolamou Cécé Moriba Loua Vincent Massala Kinda Moumouni Célia Provost Nenefing Samake Conde Sekou Abdoulaye Soumah Isabelle Arnould Michel Saa Komano Lina Gustin Carlotta Berutto Diarra Camara Fodé Saydou Camara Joliene Colpaert Léontine Delamou Lena Jansson Etienne Kourouma Maurice Loua Kristian Malme Emma Manfrin André Maomou Adele Milinouno Sien Ombelet Aboubacar Youla Sidiboun Isabelle Verreckt Pauline Yombouno Anne Bocquin Caroline Carbonnelle Thierry Carmoi Pierre Frange Stéphane Mely Vinh-Kim Nguyen Delphine Pannetier Anne-Marie Taburet Jean-Marc Treluyer Jacques Kolie Raoul Moh Minerva Cervantes Gonzalez Eeva Kuisma Britta Liedigk Didier Ngabo Martin Rudolf Ruth Thom Romy Kerber Martin Gabriel Antonino Di Caro Roman Wölfel Jamal Badir Mostafa Bentahir Yann Deccache Catherine Dumont Jean-François Durant Karim El Bakkouri Marie Gasasira Uwamahoro Benjamin Smits Nora Toufik Stéphane Van Cauwenberghe Khaled Ezzedine Eric D'Ortenzio Louis Pizarro Aurélie Etienne Jérémie Guedj Alexandra Fizet Eric Barte de Sainte Fare Bernadette Murgue Tuan Tran-Minh Christophe Rapp Pascal Piguet Marc Poncin Bertrand Draguez Thierry Allaford Duverger Solenne Barbe Guillaume Baret Isabelle Defourny Miles Carroll Hervé Raoul Augustin Augier Serge P Eholie Yazdan Yazdanpanah Claire Levy-Marchal Annick Antierrens Michel Van Herp Stephan Günther Xavier de Lamballerie Sakoba Keïta France Mentre Xavier Anglaret Denis Malvy

PLoS Med 2016 Apr 5;13(4):e1002009. Epub 2016 Apr 5.

[This corrects the article DOI: 10.1371/journal.pmed.1001967.].
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http://dx.doi.org/10.1371/journal.pmed.1002009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821578PMC
April 2016

Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

Authors:
Daouda Sissoko Cedric Laouenan Elin Folkesson Abdoul-Bing M'Lebing Abdoul-Habib Beavogui Sylvain Baize Alseny-Modet Camara Piet Maes Susan Shepherd Christine Danel Sara Carazo Mamoudou N Conde Jean-Luc Gala Géraldine Colin Hélène Savini Joseph Akoi Bore Frederic Le Marcis Fara Raymond Koundouno Frédéric Petitjean Marie-Claire Lamah Sandra Diederich Alexis Tounkara Geertrui Poelart Emmanuel Berbain Jean-Michel Dindart Sophie Duraffour Annabelle Lefevre Tamba Leno Olivier Peyrouset Léonid Irenge N'Famara Bangoura Romain Palich Julia Hinzmann Annette Kraus Thierno Sadou Barry Sakoba Berette André Bongono Mohamed Seto Camara Valérie Chanfreau Munoz Lanciné Doumbouya Souley Harouna Patient Mumbere Kighoma Fara Roger Koundouno Réné Lolamou Cécé Moriba Loua Vincent Massala Kinda Moumouni Célia Provost Nenefing Samake Conde Sekou Abdoulaye Soumah Isabelle Arnould Michel Saa Komano Lina Gustin Carlotta Berutto Diarra Camara Fodé Saydou Camara Joliene Colpaert Léontine Delamou Lena Jansson Etienne Kourouma Maurice Loua Kristian Malme Emma Manfrin André Maomou Adele Milinouno Sien Ombelet Aboubacar Youla Sidiboun Isabelle Verreckt Pauline Yombouno Anne Bocquin Caroline Carbonnelle Thierry Carmoi Pierre Frange Stéphane Mely Vinh-Kim Nguyen Delphine Pannetier Anne-Marie Taburet Jean-Marc Treluyer Jacques Kolie Raoul Moh Minerva Cervantes Gonzalez Eeva Kuisma Britta Liedigk Didier Ngabo Martin Rudolf Ruth Thom Romy Kerber Martin Gabriel Antonino Di Caro Roman Wölfel Jamal Badir Mostafa Bentahir Yann Deccache Catherine Dumont Jean-François Durant Karim El Bakkouri Marie Gasasira Uwamahoro Benjamin Smits Nora Toufik Stéphane Van Cauwenberghe Khaled Ezzedine Eric D'Ortenzio Eric Dortenzio Louis Pizarro Aurélie Etienne Jérémie Guedj Alexandra Fizet Eric Barte de Sainte Fare Bernadette Murgue Tuan Tran-Minh Christophe Rapp Pascal Piguet Marc Poncin Bertrand Draguez Thierry Allaford Duverger Solenne Barbe Guillaume Baret Isabelle Defourny Miles Carroll Hervé Raoul Augustin Augier Serge P Eholie Yazdan Yazdanpanah Claire Levy-Marchal Annick Antierrens Michel Van Herp Stephan Günther Xavier de Lamballerie Sakoba Keïta France Mentre Xavier Anglaret Denis Malvy

PLoS Med 2016 Mar 1;13(3):e1001967. Epub 2016 Mar 1.

Inserm, UMR 1219, Université de Bordeaux, Bordeaux, France.

Background: Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies.

Methods And Findings: Inclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 μmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 μmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 μmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 μmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within <72 h of symptoms compared to others. Favipiravir was well tolerated.

Conclusions: In the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia.

Trial Registration: ClinicalTrials.gov NCT02329054.
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http://dx.doi.org/10.1371/journal.pmed.1001967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773183PMC
March 2016

Clinical Management of Ebola Virus Disease in the United States and Europe.

N Engl J Med 2016 Feb;374(7):636-46

From the Centers for Disease Control and Prevention (T.M.U., J.G.) and the Division of Infectious Diseases, Emory University School of Medicine (A.K.M.) - both in Atlanta; the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (R.T.D.); Texas Health Presbyterian Hospital Dallas, Dallas (A.M.L.); the Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main (T.W.), the First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg (S.S.), and Leipzig Treatment Center for Highly Contagious Diseases, Klinikum St. Georg, Leipzig (T.G.) - all in Germany; the Division of Infectious Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva (P.V.); the Department of Infection, Royal Free London NHS Foundation Trust, London (M.J.); the Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid (J.R.A.); New York University School of Medicine-Bellevue Hospital Center, New York (L.E.); University of Nebraska Medical Center, Omaha (A.L.H.); the Departments of Infectious Diseases and Acute Medicine, Oslo University Hospital, Oslo (A.B.B.); Lazzaro Spallanzani National Institute for Infectious Diseases, Rome (G.I.); the Infectious and Tropical Diseases Department, Bégin Military Hospital, Saint-Mandé, France (C.R.); and the Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands (A.I.M.H.).

Background: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.

Methods: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.

Results: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.

Conclusions: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
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http://dx.doi.org/10.1056/NEJMoa1504874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972324PMC
February 2016

Preparation of an intensive care unit in France for the reception of a confirmed case of Ebola virus infection.

Anaesth Crit Care Pain Med 2015 Dec 24;34(6):349-55. Epub 2015 Nov 24.

Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France. Electronic address:

The current Ebola Virus Disease (EVD) outbreak in West Africa is a major challenge for the worldwide medical community. On April 29th 2015, the World Health Organization (WHO) declared 26,277 infected cases; among them, 10,884 have deceased. The epidemic is still ongoing, particularly in Sierra Leone. It is now clear that northern countries will be implicated in the care of EVD patients, both in the field and back at home. Because of the severity of EVD, a fair amount of patients may require intensive care. It is highly probable that intensive care would be able to significantly reduce the mortality linked with EVD. The preparation of a modern Intensive Care Unit (ICU) to treat an EVD patient in good conditions requires time and specific equipment. The cornerstone of this preparation includes two main goals: treating the patient and protecting healthcare providers. Staff training is time consuming and must be performed far in advance of patient arrival. To be efficient, preparation should be planned at a national level with help from public authorities, as was the case in France during the summer of 2014. Due to the severity of the disease, the high risk of transmission and scarce knowledge on EVD treatment, our propositions are necessarily original and innovative. Our review includes four topics: a brief report on the actual outbreak, where to receive and hospitalize the patients, the specific organization of the ICU and finally ethical aspects.
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http://dx.doi.org/10.1016/j.accpm.2015.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104235PMC
December 2015

Rhabdomyolysis in Ebola Virus Disease. Results of an Observational Study in a Treatment Center in Guinea.

Clin Infect Dis 2016 Jan 3;62(1):19-23. Epub 2015 Sep 3.

French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon.

Background: The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays.

Methods: We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors.

Results: High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load.

Conclusions: Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome.
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http://dx.doi.org/10.1093/cid/civ779DOI Listing
January 2016

[Ebola virus disease and accredited specialist health institutions].

Rev Infirm 2015 Jun-Jul(212):17-9

Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé cedex, France.

Ebola virus disease (EVD) went in the space of a few months from being a forgotten tropical disease to a global "health emergency". The scope of this Ebola virus epidemic (Zaire strain), which has broken out in West Africa, its spread and the high number of deaths reported among frontline health workers are unprecedented. This article describes how a specialist hospital deals with imported cases of EVD.
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http://dx.doi.org/10.1016/j.revinf.2015.04.003DOI Listing
November 2015

Delayed-onset hemolytic anemia in patients with travel-associated severe malaria treated with artesunate, France, 2011-2013.

Emerg Infect Dis 2015 May;21(5):804-12

Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.
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http://dx.doi.org/10.3201/eid2105.141171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412216PMC
May 2015

Kikuchi-Fujimoto disease: retrospective study of 91 cases and review of the literature.

Medicine (Baltimore) 2014 Nov;93(24):372-382

From the Department of Internal Medicine (GD, CR), Hôpital d'Instruction des Armées Bégin, Saint-Mandé; Department of Internal Medicine 2 (JH, ZA), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (PC), Pitié-Salpêtrière University Hospital, Paris; Department of Clinical Immunology (LG), Saint-Louis University Hospital, Paris; Department of Rheumatology (OM), Bichat University Hospital, Paris; Department of Internal Medicine (CD), Martinique University Hospital, Fort-de-France; Department of Internal Medicine (BG), Mondor University Hospital, Créteil; Department of Internal Medicine (EA), Cochin University Hospital, Paris; Department of Internal Medicine (OL), Bicêtre University Hospital, Le Kremlin-Bicêtre; Department of Internal Medicine (TP), Bichat University Hospital, Paris; Hôpital Européen Georges Pompidou (JP), Paris; Department of Internal Medicine (MH), Hôtel-Dieu University Hospital, Nantes; Department of Internal Medicine (CB), Tenon University Hospital, Paris; Department of Internal Medicine (EH), Huriez University Hospital, Lille; Department of Internal Medicine (TC), Hôpital d'Instruction des Armées du Val de Grace, Paris; Department of Internal Medicine (RD), Avicenne University Hospital, Bobigny; Department of Internal Medicine (MG, AM, OF), Jean Verdier University Hospital, Bondy; Department of Pathology (FC), Pitié-Salpêtrière University Hospital, Paris; Department of Internal Medicine (DF), Saint-Louis University Hospital, Paris; Department of Pathology (TM), Necker University Hospital, Paris; France; and Department of Internal Medicine (VP), Hôpital des Trois-Chêne, Hôpitaux Universitaires de Genève, Genève; and Department of Internal Medicine (JS), Hôpitaux Universitaires de Genève, Genève, Switzerland. Drs. Prendki and Fain contributed equally.

Kikuchi-Fujimoto disease (KFD) is a rare cause of lymphadenopathy, most often cervical. It has been mainly described in Asia. There are few data available on this disease in Europe. We conducted this retrospective, observational, multicenter study to describe KFD in France and to determine the characteristics of severe forms of the disease and forms associated with systemic lupus erythematosus (SLE). We included 91 cases of KFD, diagnosed between January 1989 and January 2011 in 13 French hospital centers (median age, 30 ± 10.4 yr; 77% female). The ethnic origins of the patients were European (33%), Afro-Caribbean (32%), North African (15.4%), and Asian (13%). Eighteen patients had a history of systemic disease, including 11 with SLE. Lymph node involvement was cervical (90%), often in the context of polyadenopathy (52%), and it was associated with hepatomegaly and splenomegaly in 14.8% of cases. Deeper sites of involvement were noted in 18% of cases. Constitutional signs consisted mainly of fever (67%), asthenia (74.4%), and weight loss (51.2%). Other manifestations included skin rash (32.9%), arthromyalgia (34.1%), 2 cases of aseptic meningitis, and 3 cases of hemophagocytic lymphohistiocytosis. Biological signs included lymphocytopenia (63.8%) and increase of acute phase reactants (56.4%). Antinuclear antibodies (ANAs) and anti-DNA antibodies were present in 45.2% and 18% of the patients sampled, respectively. Concomitant viral infection was detected in 8 patients (8.8%). Systemic corticosteroids were prescribed in 32% of cases, hydroxychloroquine in 17.6%, and intravenous immunoglobulin in 3 patients. The disease course was always favorable. Recurrence was observed in 21% of cases. In the 33 patients with ANA at diagnosis, SLE was known in 11 patients, diagnosed concomitantly in 10 cases and in the year following diagnosis in 2 cases; 6 patients did not have SLE, and 4 patients were lost to follow-up (median follow-up, 19 mo; range, 3-39 mo). The presence of weight loss, arthralgia, skin lesions, and ANA was associated with the development of SLE (p < 0.05). Male sex and lymphopenia were associated with severe forms of KFD (p < 0.05). KFD can occur in all populations, irrespective of ethnic origin. Deep forms are common. An association with SLE should be investigated. A prospective study is required to determine the risk factors for the development of SLE.
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http://dx.doi.org/10.1097/MD.0000000000000220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602439PMC
November 2014

Travel-associated infection presenting in Europe (2008-12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation.

Lancet Infect Dis 2015 Jan 2;15(1):55-64. Epub 2014 Dec 2.

Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Background: Travel is important in the acquisition and dissemination of infection. We aimed to assess European surveillance data for travel-related illness to profile imported infections, track trends, identify risk groups, and assess the usefulness of pre-travel advice.

Methods: We analysed travel-associated morbidity in ill travellers presenting at EuroTravNet sites during the 5-year period of 2008-12. We calculated proportionate morbidity per 1000 ill travellers and made comparisons over time and between subgroups. We did 5-year trend analyses (2008-12) by testing differences in proportions between subgroups using Pearson's χ(2) test. We assessed the effect of the pre-travel consultation on infection acquisition and outcome by use of proportionate morbidity ratios.

Findings: The top diagnoses in 32 136 patients, ranked by proportionate morbidity, were malaria and acute diarrhoea, both with high proportionate morbidity (>60). Dengue, giardiasis, and insect bites had high proportionate morbidity (>30) as well. 5-year analyses showed increases in vector borne infections with significant peaks in 2010; examples were increased Plasmodium falciparum malaria (χ(2)=37·57, p<0·001); increased dengue fever (χ(2)=135·9, p<0·001); and a widening geographic range of acquisition of chikungunya fever. The proportionate morbidity of dengue increased from 22 in 2008 to 36 in 2012. Five dengue cases acquired in Europe contributed to this increase. Dermatological diagnoses increased from 851 in 2008 to 1102 in 2012, especially insect bites and animal-related injuries. Respiratory infection trends were dominated by the influenza H1N1 pandemic in 2009. Illness acquired in Europe accounted for 1794 (6%) of all 32 136 cases-mainly, gastrointestinal (634) and respiratory (357) infections. Migration within Europe was associated with more serious infection such as hepatitis C, tuberculosis, hepatitis B, and HIV/AIDS. Pre-travel consultation was associated with significantly lower proportionate morbidity ratios for P falciparum malaria and also for acute hepatitis and HIV/AIDS.

Interpretation: The pattern of travel-related infections presenting in Europe is complex. Trend analyses can inform on emerging infection threats. Pre-travel consultation is associated with reduced malaria proportionate morbidity ratios and less severe illness. These findings support the importance and effectiveness of pre-travel advice on malaria prevention, but cast doubt on the effectiveness of current strategies to prevent travel-related diarrhoea.

Funding: European Centre for Disease Prevention and Control, University Hospital Institute Méditerranée Infection, US Centers for Disease Control and Prevention, and the International Society of Travel Medicine.
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http://dx.doi.org/10.1016/S1473-3099(14)71000-XDOI Listing
January 2015

[Ebola virus epidemic in West Africa: facts and prospects].

Authors:
Christophe Rapp

Med Sante Trop 2014 Jul-Sep;24(3):229-31

Service des maladies infectieuses et tropicales, hôpital d'instruction des armées Bégin, Saint-Mandé, France.

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http://dx.doi.org/10.1684/mst.2014.0400DOI Listing
May 2016

Spectrum and impact of health problems during deployment: a prospective, multicenter study of French soldiers operating in Afghanistan, Lebanon and Côte d'Ivoire.

Travel Med Infect Dis 2014 Jul-Aug;12(4):378-84. Epub 2014 May 22.

Service des maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France; Ecole du Val de Grace, Paris, France. Electronic address:

Background: More than 15 000 French soldiers are continuously deployed abroad. Along with combat-related injuries, they are exposed to non-combat-related diseases with an underestimated burden. Our objectives were to assess the incidence and impact of health problems on their operating capacity.

Methods: A prospective multicenter study was conducted over more than three months in Lebanon, Côte d'Ivoire and Afghanistan including exclusively French soldiers.

Results: We collected 4349 consultations (Afghanistan {n = 719}, Lebanon {n = 1401} and Côte d'Ivoire {n = 2229}) encompassing 4600 health problems. Injuries (21%), diarrhea (19%), dermatoses (17.5%) and respiratory tract infections (10.45%) were the most frequent health issues. Infectious diseases represented 41% of all health problems. Almost nine out of ten patients were managed as outpatients. Ten combat-related deaths were observed. We reported 68 (1.5%) medical repatriations of which 28 and 26 were psychiatric and trauma cases respectively. Partial or complete incapacity was estimated 724 days/1000 men/month. Etiological spectrum was similar in all three countries however, the incidence of diarrhea (p < 0.05) as well as inpatient management and medical evacuation rates were higher (p < 0.0001) in Afghanistan.

Conclusions: There was a wide spectrum of health problems occurring during military deployments with a predominance of common infections. Non-combat-related pathology represented an important burden for the loss of operating capacity.
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http://dx.doi.org/10.1016/j.tmaid.2014.05.002DOI Listing
March 2015

Prevention of combat-related infections: antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities.

Travel Med Infect Dis 2014 Jul-Aug;12(4):318-29. Epub 2014 May 11.

Epidemiology and Public Health Department CESPA, Camp de Sainte-Marthe, 408 rue Jean Queillau, 13014 Marseille, France.

Infection is a major complication associated with combat-related injuries. Beside immobilization, wound irrigation, surgical debridement and delayed coverage, post-injury antimicrobials contribute to reduce combat-related infections, particularly those caused by bacteria of the early contamination flora. In modern warfare, bacteria involved in combat-related infections are mainly Gram-negative bacteria belonging to the late contamination flora. These bacteria are frequently resistant or multiresistant to antibiotics and spread through the deployed chain of care. This article exposes the principles of war wounds antimicrobial prophylaxis recommended in the French Armed Forces and highlights the need for high compliance to hygiene standard precautions, adapted contact precautions and judicious use of antibiotics in French deployed military medical treatment facilities (MTF).
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http://dx.doi.org/10.1016/j.tmaid.2014.04.013DOI Listing
March 2015

Travel-related infection in European travelers, EuroTravNet 2011.

J Travel Med 2014 Jul-Aug;21(4):248-54. Epub 2014 Apr 20.

Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, UK.

Background: Limited data exist on infectious diseases imported to various locations in Europe, particularly after travel within the continent.

Methods: To investigate travel-related disease relevant to Europe that is potentially preventable through pre-travel intervention, we analyzed the EuroTravNet database of 5,965 ill travelers reported by 16 centers in "Western" Europe in 2011.

Results: There were 54 cases of vaccine-preventable disease, mostly hepatitis A (n = 16), typhoid fever (n = 11), and measles (n = 8); 6 cases (including 3 measles cases) were associated with travel within "Western" Europe. Malaria was the most commonly diagnosed infection (n = 482, 8.1% of all travel-related morbidity). Among patients with malaria, the military most commonly received pre-travel advice (95%), followed by travelers for missionary, volunteer, research, or aid work (81%) but travelers visiting friends and relatives (VFRs) were least likely to receive pre-travel advice (21%). The vast majority (96%) of malaria patients were resident in "Western" Europe, but over half (56%) were born elsewhere. Other significant causes of morbidity, which could be reduced through advice and behavioral change, include Giardia (n = 221, 3.7%), dengue (n = 146, 2.4%), and schistosomiasis (n = 131, 2.2%). Of 206 (3.5%) travelers with exposure in "Western" Europe, 75% were tourists; the highest burden of disease was acute gastrointestinal infection (35% cases). Travel from "Eastern" Europe (n = 132, 2.2%) was largely associated with migration-related travel (53%); among chronic infectious diseases, tuberculosis was frequently diagnosed (n = 20). Travelers VFRs contributed the largest group of malaria patients (46%), but also had the lowest documented rate of pre-travel health advice in this subset (20%). Overall, 44% of nonimmigrant ill travelers did not receive pre-travel advice.

Conclusion: There is a burden of infectious diseases in travelers attending European health centers that is potentially preventable through comprehensive pre-travel advice, chemoprophylaxis, and vaccination. Targeted interventions for high-risk groups such as travelers VFRs and migration-associated travelers are of particular importance.
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http://dx.doi.org/10.1111/jtm.12120DOI Listing
February 2015

Sensitivity of parasitological tests in imported Plasmodium vivax malaria in adults and impact of chemoprophylaxis and attack type.

J Travel Med 2014 May-Jun;21(3):195-200. Epub 2014 Mar 14.

Service de Biologie Médicale.

Background: Plasmodium vivax is the second most common species among cases of imported malaria diagnosed in Europe. The objective of this study is to describe the sensitivity of the parasitological tests in imported P. vivax malaria, and the impact of chemoprophylaxis and attack type (primary infection or relapse).

Methods: A retrospective study included the imported vivax malaria cases admitted in a French military hospital between 2001 and 2013. The reference diagnosis method was microscopy corrected by polymerase chain reaction (PCR). Thin and thick blood films examination, quantitative buffy coat (QBC) test, and a rapid diagnostic test (RDT) had been systematically performed. PCR had been carried out for ambiguous profiles.

Results: Eighty-nine cases recorded from 78 patients were included, 65 of them having recently traveled to French Guyana. Forty-two patients had properly followed chemoprophylaxis. Forty-six cases were primary infections while 43 were relapses. The sensitivity was 91% for the thin blood smear, 96% for the concentration techniques (Giemsa thick blood smear and QBC test), and 76% for the RDT. The combination of the three conventional tools has an imperfect sensitivity, both for the positive diagnosis of malaria (96%) and for the diagnosis of vivax species (80%). In 4% of the cases, the positive diagnosis was established only by the PCR. The species identification was established in 20% by the PCR. The sensibility of thin blood smear and of RDT decreased significantly with full compliance of chemoprophylaxis or primary infection, whereas the decrease of sensibility of concentration techniques was not significant.

Conclusions: This study illustrates the difficulties encountered in vivax malaria diagnosis, especially in patients who properly followed chemoprophylaxis or with primary infection due to a lower parasitemia. It underlines the lack of sensitivity of RDT for P. vivax and emphasizes the need for systematically combining various diagnosis methods.
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http://dx.doi.org/10.1111/jtm.12116DOI Listing
December 2014

The 2009 A(H1N1) influenza pandemic in the French Armed Forces: epidemiological surveillance and operational management.

Mil Med 2014 Feb;179(2):183-9

Military Centre for Epidemiology and Public Health (CESPA), GSBdD Marseille Aubagne, 111 Avenue de la Corse, BP40026, Marseille 13568, France.

Objective: The main objective of this study was to evaluate the contribution of a newly implemented daily surveillance system to the management of the 2009 A(H1N1) influenza pandemic by the military decision-makers at different levels in the French Department of Defence.

Methods: The study sample included all medical advisors in the Ministry of Defence and the French Armed Forces Staff and also the members of the specific committee dedicated to flu pandemic control. The variables studied were mental representation of epidemiology, relevance, usefulness, and real-time use of surveillance data using quantitative questionnaires and qualitative face-to-face semistructured interviews.

Results: Among the risk managers of the flu pandemic in the Armed Forces, 84% responded. The data generated by epidemiological surveillance were considered relevant and useful, and were reported as effectively used. On the basis of the information produced, concrete actions were planned and implemented in the French Armed Forces.

Conclusion: In a pandemic situation involving low mortality, the daily monitoring of the disease did not target public health issues, but it was mainly used to assess the availability of the Armed Forces in real time. For the military staff, epidemiological surveillance represents an essential information tool for the conduct of operations.
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http://dx.doi.org/10.7205/MILMED-D-13-00261DOI Listing
February 2014