Arnaud Tarantola

Background: Estimates of leptospirosis morbidity identified Oceania as the region with highest burden. Besides Australia and New Zealand, Oceania is home of Pacific Island Countries and Territories,
most of which are developing countries facing a number of challenges. Their archipelago geography notably affects health infrastructure and access to healthcare. Although human leptospirosis was formerly identified in Vanuatu, there is a lack of knowledge of this
disease in the country. We aimed to identify leptospirosis in outpatients visiting the hospital.
Methodology/Principal findings: We conducted a clinical study to investigate leptospirosis as a cause of non-malarial acute febrile illness in Vanuatu. A total 161 outpatients visiting the outpatient clinics at Port Vila Central Hospital for internal medicine were recruited over 20 month. We showed that leptospirosis significantly affects humans in Vanuatu: 12 cases were confirmed by real-time PCR on acute blood samples (n = 5) or by high serology titers evidencing a recent infection (MAT titer 800 or ELISA18 Units, n = 7). A high rate of positive serology was also evidenced,
by MAT (100<titer<800, 9 patients) or ELISA IgM (ELISA12 Units, 20 patients, including 6 also positive in MAT), showing frequent exposure to pathogenic leptospires, notably from serogroup Australis.
Conclusions/Significance: The high numbers of both seropositive patients and acute leptospirosis cases observed in
outpatients visiting Port Vila Central Hospital suggest a high exposure to pathogenic Leptospira in the population studied. The MAT serology pointing to serogroup Australis as
well as exposure history suggest that livestock animals largely contribute to the burden of
human leptospirosis in Vanuatu. The analysis of residential and travel data suggests that the risk might even be higher in other islands of the Vanuatu archipelago. Altogether, our study emphasizes the need to increase awareness and build laboratory capacity to improve the medical care of leptospirosis in Vanuatu.

The French public health institute is responsible for promoting and coordinating threats the detection and assessment of health risks, and for suggesting possible responses. Transmissible diseases affecting both human and animal health are the focus of surveillance networks. Early detection of potential infectious threats is based on the screening of &quot;alert signals&quot; identified through routine surveillance networks and other systems. The quality and accuracy of these signals is first verified, before assessing, through a multidisciplinary approach, the risk of introduction and dissemination. This article examines specific cases illustrating the process of detection, risk analysis and response, with respect to infectious threats that are endemic in tropical regions and have the potential to be imported into metropolitan France. For both novel pathogens and exotic diseases--which, not being endemic in France, are less well known--the analysis and response process must regular...

Although limited publications address clinical management of symptomatic rabies patients in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to rabies patients and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries. This article is protected by copyright. All rights reserved.

This first extensive retrospective study of the molecular epidemiology of dog rabies in Cambodia included 149 rabies virus (RABV) entire nucleoprotein sequences obtained from 1998-2011. The sequences were analyzed in conjunction with RABVs from other Asian countries. Phylogenetic reconstruction confirmed the South-East Asian phylogenetic clade comprising viruses from Cambodia, Vietnam, Thailand, Laos and Myanmar. The present study represents the first attempt to classify the phylogenetic lineages inside this clade, resulting in the confirmation that all the Cambodian viruses belonged to the South-East Asian (SEA) clade. Three distinct phylogenetic lineages in the region were established with the majority of viruses from Cambodia closely related to viruses from Thailand, Laos and Vietnam, forming the geographically widespread phylogenetic lineage SEA1. A South-East Asian lineage SEA2 comprised two viruses from Cambodia was identified, which shared a common ancestor with RABVs originating from Laos. Viruses from Myanmar formed separate phylogenetic lineages within the major SEA clade. Bayesian molecular clock analysis suggested that the time to most recent common ancestor (TMRCA) of all Cambodian RABVs dated to around 1950. The TMRCA of the Cambodian SEA1 lineage was around 1964 and that of the SEA2 lineage was around 1953. The results identified three phylogenetically distinct and geographically separated lineages inside the earlier identified major SEA clade, covering at least five countries in the region. A greater understanding of the molecular epidemiology of rabies in South-East Asia is an important step to monitor progress on the efforts to control canine rabies in the region.

Three-quarters of the estimated 390 million dengue virus (DENV) infections each year are clinically inapparent. People with inapparent dengue virus infections are generally considered dead-end hosts for transmission because they do not reach sufficiently high viremia levels to infect mosquitoes. Here, we show that, despite their lower average level of viremia, asymptomatic people can be infectious to mosquitoes. Moreover, at a given level of viremia, DENV-infected people with no detectable symptoms or before the onset of symptoms are significantly more infectious to mosquitoes than people with symptomatic infections. Because DENV viremic people without clinical symptoms may be exposed to more mosquitoes through their undisrupted daily routines than sick people and represent the bulk of DENV infections, our data indicate that they have the potential to contribute significantly more to virus transmission to mosquitoes than previously recognized.

Enterovirus 71 is reported to have emerged in Cambodia in 2012; at least 54 children with severe encephalitis died during that outbreak. We used serum samples collected during 2000-2011 to show that the virus had been widespread in the country for at least a decade before the 2012 outbreak.

Dengue laboratory diagnosis is essentially based on detection of the virus, its components or antibodies directed against the virus in blood samples. Blood, however, may be difficult to draw in some patients, especially in children, and sampling during outbreak investigations or epidemiological studies may face logistical challenges or limited compliance to invasive procedures from subjects. The aim of this study was to assess the possibility of using saliva and urine samples instead of blood for dengue diagnosis. Serial plasma, urine and saliva samples were collected at several time-points between the day of admission to hospital until three months after the onset of fever in children with confirmed dengue disease. Quantitative RT-PCR, NS1 antigen capture and ELISA serology for anti-DENV antibody (IgG, IgM and IgA) detection were performed in parallel on the three body fluids. RT-PCR and NS1 tests demonstrated an overall sensitivity of 85.4%/63.4%, 41.6%/14.5% and 39%/28.3%, in pla...

The French public health institute is responsible for promoting and coordinating threats the detection and assessment of health risks, and for suggesting possible responses. Transmissible diseases affecting both human and animal health are the focus of surveillance networks. Early detection of potential infectious threats is based on the screening of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;alert signals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; identified through routine surveillance networks and other systems. The quality and accuracy of these signals is first verified, before assessing, through a multidisciplinary approach, the risk of introduction and dissemination. This article examines specific cases illustrating the process of detection, risk analysis and response, with respect to infectious threats that are endemic in tropical regions and have the potential to be imported into metropolitan France. For both novel pathogens and exotic diseases--which, not being endemic in France, are less well known--the analysis and response process must regularly be adapted to the latest epidemiological, clinical and biological findings, taking interactions between the pathogen, host, and environment into consideration. The need to improve reaction times and risk assessment is also discussed.

Plague is circulating regularly in localised areas worldwide, causing sporadic cases outside Africa and remains endemic or causes limited outbreaks in some African countries. Furthermore, some notable outbreaks have been reported in Asia in the last 20 years. A limited outbreak with five cases has recently been notified by the health authorities of the Libyan Arab Jamahiriya.

Authorities have pledged to eliminate canine rabies by 2020 in Cambodia, a country with a very high rabies burden. Logistic and financial access to timely and adequate postexposure prophylaxis (PEP) is essential for preventing rabies in humans. We undertook a survey of the few identified sites where PEP rabies vaccination and rabies immunoglobulin (RIG) are available in Cambodia. We examined the Rabies Prevention Center at Institut Pasteur du Cambodge (rpc@ipc) database and rpc@ipc order forms for 2012 to assess vaccine and RIG use. We conducted a rapid internet survey of centers that provide rabies vaccine and RIG in Cambodia, other than rpc@ipc. The cost of a full course of intramuscular or intradermal PEP in Cambodia, with and without RIG, was also estimated. Rabies vaccination is free of charge in one foundation hospital and is accessible for a fee at Institut Pasteur du Cambodge (IPC), some institutions, and some Cambodian private clinics. In 2012, 27,500 rabies vaccine doses (0.5 mL) and 591 equine RIG doses were used to provide intradermal PEP to 20,610 persons at rpc@ipc following animal bites. Outside of rpc@ipc, an estimated total of 53,400 vaccine doses and 200 RIG doses were used in Cambodia in 2012. The wholesale cost of full rabies PEP was estimated at 50% to 100% of a Cambodian farmer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s monthly wage. Local populations and travelers cannot be sure to locally access adequate and timely PEP due to high costs and low access to RIG. Travelers to high-endemic areas such as Cambodia are strongly encouraged to undergo pre-exposure vaccination or seek expert advice, as per World Health Organization (WHO) recommendations. State-subsidized, pre-positioned stocks of human vaccine and RIG in bite management centers would extend the rabies prevention centers network. Support from Institut Pasteur du Cambodge for staff training, cold chain, and quality control would contribute to reducing the risk of rabies deaths in Cambodia.

En France, la surveillance des contaminations professionnelles chez le personnel de santé a été instaurée dés 1991 pour le virus de l&#39;immunodéficience humaine (VIH) et en 1997 pour le virus de l&#39;hépatite C (VHC). Cette surveillance repose sur plusieurs sources d&#39;information : données recueillies par les médecins du travail de tous les établissemens de soins publics et privés (soit environ 2500 établissements, déclarations obligatoires de SIDA chez les personnels de santé, les déclarations d&#39;accident du travail dans le cadre du régime général de la sécurité sociale, suivis sérologiques des patients obtenus dans le cadre de l&#39;évaluation nationale des prescriptions de prophylaxie antirétrovirale après exposition. Au 30 juin 2001, ont été recensés 13 cas de séroconversions VIH (toutes liées à une piqûre) et 43 séroconversions VHC (liées à une piqûre dans 40 cas, à une coupure dans deux cas et à un contact sur peau lésée dans un cas). Aucune nouvelle contamination pro...

Summary: Une enquête rétrospective a été réalisée chez des soignants de trois pays d&#39;Afrique de l&#39;Ouest afin d&#39;estimer leur risque de contamination professionnelle suite à un accident exposant au sang (AES). L&#39;incidence estimée des AES est élevée dans ces pays, puisqu&#39;elle est de 0,69 AES par infirmière et par an (0,57-0,84) et de 2,19 par chirurgien et par an (1,92-2,49). La formation de ces personnels à la prévention des AES constitue une priorité pour les aider à prodiguer des soins de qualité pour les patients. Les spécialités de la mise en place de programmes de prévention dans ces pays, les enseignements tirés du projet &quot;Trois Pays&quot; et les perspectives de collaboration dans les années à venir sont détaillés dans cet article.(RESUME D&#39;AUTEUR) A retrospective survey was conducted amongst healthcare workers in three West African countries in order to estimate their risk of occupational infection following accidental blood exposure (ABE). The esti...

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.

From January to September 2013, a marked increase in notifications of Salmonella Paratyphi A infections among travellers returning from Cambodia occurred in France. An investigation revealed 35 cases without a common source: 21 in France, five in Germany, three in the Netherlands, one in Norway, one in the United Kingdom, four in New-Zealand. Data suggest an ongoing event that should trigger further investigation. Travellers to Cambodia should observe preventive measures including good personal hygiene and food handling practices.

An estimation of the number of Trypanosoma cruzi infected individuals and expected number of Chagasic cardiomyopathies in France (excluding French Guyana) was conducted in June, 2009 by InVS. Different risk groups were identified: Latino-Americans (LA) from endemic area (naturalized, legal and illegal migrants, adopted children), children born from LA&#39;s mother, French Guyanese living in Metropolitan France, expatriated and travellers from endemic countries. Prevalence rates by country of origin were applied to official data on risk populations obtained from the International Adoption Agency, Tourism Direction and French ministries (Finances, Foreign Affairs and Migrations). Around 157,000 individuals were potentially exposed. It is estimated than 1,464 [895-2,619] are infected by T. cruzi, of which 63 to 555 may evolve towards a chronic cardiomyopathy. This figure is within the range of earlier estimations of InVS and Guerri-Guttenberg. Taking into account illegal immigrants, th...

... by Arnaud P. Tarantola, Anne C. Rachline, Cyril Konto, Sandrine Houze, Sylvie Lariven, Anika Fichelle, David Ammar, Christiane Sabah-Mondan, Helene ... complication of transfusion (1). Malaria has also been diagnosed after intravenous drug use (2,3) and breaches in infection ...

A national survey was conducted with 5,000 randomly chosen surgeons in order to assess the methods of protection used or warranted in the operating room against blood-borne pathogens. The rate of complete vaccination against hepatitis B was 79.2%. The use of double gloves was constant for 72% of orthopedist surgeons but only reached 28.2% for the overall surgical population. Only 46.1% of the gowns used were coated, though the quality of the barrier when it is wet is very risky. The protections taken in the operating room against blood-borne pathogens can be improved.

The epidemiology of several viral diseases underwent profound changes in South-East Asia and Oceania over the past decades. This was due to several factors, including the geographical distribution of vectors and the viruses they transmit; increasing traveling and trade; increasing ecological and demographic pressure. We reviewed the current state of knowledge based on published sources and available epidemiological data. The review was limited to potentially emerging viruses in Southeast Asia and the Pacific reported in human cases. Dengue, Chikungunya, and Japanese Encephalitis viruses have recurred on a yearly basis with a steady increase in these regions. Ross River and Barmah viruses now appear regularly in Australia, in an increasing number of cases. Nipah virus strikes regularly with limited but deadly epidemics in Southeast Asia. Finally, infections by lyssaviruses, Kunjin, Murray Valley, or Zika viruses were also reviewed.