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Teiti I, Aubry M, Fernandes-Pellerin S, Patin E, Madec Y, Boucheron P, Vanhomwegen J, Torterat J, Lastère S, Olivier S, Jaquaniello A, Roux M, Mendiboure V, Harmant C, Bisiaux A, Rijo de León G, Liu D, Bossin H, Mathieu-Daudé F, Gatti C, Suhas E, Chung K, Condat B, Ayotte P, Conte E, Jolly N, Manuguerra JC, Sakuntabhai A, Fontanet A, Quintana-Murci L, Cao-Lormeau VM. Unravelling the determinants of human health in French Polynesia: the MATAEA project. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1201038. [PMID: 38455935 PMCID: PMC10911015 DOI: 10.3389/fepid.2023.1201038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/15/2023] [Indexed: 03/09/2024]
Abstract
Background French Polynesia is a French overseas collectivity in the Southeast Pacific, comprising 75 inhabited islands across five archipelagoes. The human settlement of the region corresponds to the last massive migration of humans to empty territories, but its timeline is still debated. Despite their recent population history and geographical isolation, inhabitants of French Polynesia experience health issues similar to those of continental countries. Modern lifestyles and increased longevity have led to a rise in non-communicable diseases (NCDs) such as obesity, diabetes, hypertension, and cardiovascular diseases. Likewise, international trade and people mobility have caused the emergence of communicable diseases (CDs) including mosquito-borne and respiratory diseases. Additionally, chronic pathologies including acute rheumatic fever, liver diseases, and ciguatera, are highly prevalent in French Polynesia. However, data on such diseases are scarce and not representative of the geographic fragmentation of the population. Objectives The present project aims to estimate the prevalence of several NCDs and CDs in the population of the five archipelagoes, and identify associated risk factors. Moreover, genetic analyses will contribute to determine the sequence and timings of the peopling history of French Polynesia, and identify causal links between past genetic adaptation to island environments, and present-day susceptibility to certain diseases. Methods This cross-sectional survey is based on the random selection of 2,100 adults aged 18-69 years and residing on 18 islands from the five archipelagoes. Each participant answered a questionnaire on a wide range of topics (including demographic characteristics, lifestyle habits and medical history), underwent physical measurements (height, weight, waist circumference, arterial pressure, and skin pigmentation), and provided biological samples (blood, saliva, and stool) for biological, genetic and microbiological analyses. Conclusion For the first time in French Polynesia, the present project allows to collect a wide range of data to explore the existence of indicators and/or risk factors for multiple pathologies of public health concern. The results will help health authorities to adapt actions and preventive measures aimed at reducing the incidence of NCDs and CDs. Moreover, the new genomic data generated in this study, combined with anthropological data, will increase our understanding of the peopling history of French Polynesia. Clinical trial registration https://clinicaltrials.gov/, identifier: NCT06133400.
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Affiliation(s)
- Iotefa Teiti
- Laboratory of Research on Emerging Viral Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | - Maite Aubry
- Laboratory of Research on Emerging Viral Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | | | - Etienne Patin
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases Unit, Paris, France
| | - Pauline Boucheron
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases Unit, Paris, France
| | - Jessica Vanhomwegen
- Environment and Infectious Risk Unit, Laboratory for Urgent Response to Biological Threats, Institut Pasteur, Paris, France
| | - Jérémie Torterat
- Institut de la Statistique de la Polynésie Française, Papeete, French Polynesia
| | - Stéphane Lastère
- Clinical Laboratory, Centre Hospitalier de la Polynésie Française, Pirae, French Polynesia
| | - Sophie Olivier
- Clinical Laboratory, Institut Louis Malardé, Papeete, French Polynesia
| | - Anthony Jaquaniello
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Institut Pasteur, Data Management Core Facility, Paris, France
| | - Maguelonne Roux
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Institut Pasteur, Université de Paris, Bioinformatics and Biostatistics Hub, Paris, France
| | - Vincent Mendiboure
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases Unit, Paris, France
| | - Christine Harmant
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Aurélie Bisiaux
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Gaston Rijo de León
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Dang Liu
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Hervé Bossin
- Laboratory of Research in Medical Entomology, Institut Louis Malardé, Paea, French Polynesia
| | - Françoise Mathieu-Daudé
- Laboratory of Research in Medical Entomology, Institut Louis Malardé, Paea, French Polynesia
- UMR MIVEGEC-Infectious Diseases and Vectors, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Clémence Gatti
- Laboratory of Marine Biotoxins, UMR241-Ecosystèmes Insulaires Océaniens (EIO) (IFREMER, ILM, IRD, UPF), Institut Louis Malardé, Papeete, French Polynesia
| | - Edouard Suhas
- Unit on non-Communicable Diseases, UMR241-Ecosystèmes Insulaires Océaniens (EIO) (IFREMER, ILM, IRD, UPF), Institut Louis Malardé, Papeete, French Polynesia
| | - Kiyojiken Chung
- Laboratory of Research on Emerging Viral Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | - Bertrand Condat
- Department of Gastroenterology, Centre Hospitalier de la Polynésie Française, Pirae, French Polynesia
| | - Pierre Ayotte
- Centre de Toxicologie du Québec, Institut National de Santé Publique du Québec, QC, Canada
| | - Eric Conte
- Maison des Sciences de l’Homme du Pacifique, Université de la Polynésie Française, Punaauia, French Polynesia
| | - Nathalie Jolly
- Center for Translational Sciences, Institut Pasteur, Paris, France
| | - Jean-Claude Manuguerra
- Environment and Infectious Risk Unit, Laboratory for Urgent Response to Biological Threats, Institut Pasteur, Paris, France
| | - Anavaj Sakuntabhai
- Functional Genetics of Infectious Diseases Unit, Department of Global Health, Institut Pasteur, Paris, France
| | - Arnaud Fontanet
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases Unit, Paris, France
- PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | - Lluis Quintana-Murci
- Institut Pasteur, Université Paris Cité, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Chair Human Genomics and Evolution, Collège de France, Paris, France
| | - Van-Mai Cao-Lormeau
- Laboratory of Research on Emerging Viral Diseases, Institut Louis Malardé, Papeete, French Polynesia
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Eke AC, Eleje GU, Eke UA, Xia Y, Liu J. Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus. Cochrane Database Syst Rev 2017; 2:CD008545. [PMID: 28188612 PMCID: PMC6464495 DOI: 10.1002/14651858.cd008545.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis is a viral infection of the liver. It is mainly transmitted between people through contact with infected blood, frequently from mother to baby in-utero. Hepatitis B poses significant risk to the fetus and up to 85% of infants infected by their mothers at birth develop chronic hepatitis B virus (HBV) infection. Hepatitis B immunoglobulin (HBIG) is a purified solution of human immunoglobulin that could be administered to the mother, newborn, or both. HBIG offers protection against HBV infection when administered to pregnant women who test positive for hepatitis B envelope antigen (HBeAg) or hepatitis B surface antigen (HBsAg), or both. When HBIG is administered to pregnant women, the antibodies passively diffuse across the placenta to the child. This materno-fetal diffusion is maximal during the third trimester of pregnancy. Up to 1% to 9% infants born to HBV-carrying mothers still have HBV infection despite the newborn receiving HBIG plus active HBV vaccine in the immediate neonatal period. This suggests that additional intervention such as HBIG administration to the mother during the antenatal period could be beneficial to reduce the transmission rate in utero. OBJECTIVES To determine the benefits and harms of hepatitis B immunoglobulin (HBIG) administration to pregnant women during their third trimester of pregnancy for the prevention of mother-to-child transmission of hepatitis B virus infection. SEARCH METHODS We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded (Web of Science), SCOPUS, African Journals OnLine, and INDEX MEDICUS up to June 2016. We searched ClinicalTrials.gov and portal of the WHO International Clinical Trials Registry Platform (ICTRP) in December 2016. SELECTION CRITERIA We included randomised clinical trials comparing HBIG versus placebo or no intervention in pregnant women with HBV. DATA COLLECTION AND ANALYSIS Two authors extracted data independently. We analysed dichotomous outcome data using risk ratio (RR) and continuous outcome data using mean difference (MD) with 95% confidence intervals (CI). For meta-analyses, we used a fixed-effect model and a random-effects model, along with an assessment of heterogeneity. If there were statistically significant discrepancies in the results, we reported the more conservative point estimate. If the two estimates were equal, we used the estimate with the widest CI as our main result. We assessed bias control using the Cochrane Hepato-Biliary Group suggested bias risk domains and risk of random errors using Trial Sequential Analysis (TSA). We assessed the quality of the evidence using GRADE. MAIN RESULTS All 36 included trials originated from China and were at overall high risk of bias. The trials included 6044 pregnant women who were HBsAg, HBeAg, or hepatitis B virus DNA (HBV-DNA) positive. Only seven trials reported inclusion of HBeAg-positive mothers. All 36 trials compared HBIG versus no intervention. None of the trials used placebo.Most of the trials assessed HBIG 100 IU (two trials) and HBIG 200 IU (31 trials). The timing of administration of HBIG varied; 30 trials administered three doses of HBIG 200 IU at 28, 32, and 36 weeks of pregnancy. None of the trials reported all-cause mortality or other serious adverse events in the mothers or babies. Serological signs of hepatitis B infection of the newborns were reported as HBsAg, HBeAg, and HBV-DNA positive results at end of follow-up. Twenty-nine trials reported HBsAg status in newborns (median 1.2 months of follow-up after birth; range 0 to 12 months); seven trials reported HBeAg status (median 1.1 months of follow-up after birth; range 0 to 12 months); and 16 trials reported HBV-DNA status (median 1.2 months of follow-up; range 0 to 12 months). HBIG reduced mother-to-child transmission (MTCT) of HBsAg when compared with no intervention (179/2769 (6%) with HBIG versus 537/2541 (21%) with no intervention; RR 0.30, TSA-adjusted CI 0.20 to 0.52; I2 = 36%; 29 trials; 5310 participants; very low quality evidence). HBV-DNA reduced MTCT of HBsAg (104/1112 (9%) with HBV-DNA versus 382/1018 (38%) with no intervention; RR 0.25, TSA-adjusted CI 0.22 to 0.27; I2 = 84%; 16 trials; 2130 participants; low quality evidence). TSA supported both results. Meta-analysis showed that maternal HBIG did not decrease HBeAg in newborns compared with no intervention (184/889 (21%) with HBIG versus 232/875 (27%) with no intervention; RR 0.68, TSA-adjusted CI 0.04 to 6.37; I2 = 90%; 7 trials; 1764 participants; very low quality evidence). TSA could neither support nor refute this observation as data were too sparse. None of the trials reported adverse events of the immunoglobulins on the newborns, presence of local and systemic adverse events on the mothers, or cost-effectiveness of treatment. AUTHORS' CONCLUSIONS Due to very low to low quality evidence found in this review, we are uncertain of the effect of benefit of antenatal HBIG administration to the HBV-infected mothers on newborn outcomes, such as HBsAg, HBV-DNA, and HBeAg compared with no intervention. The results of the effects of HBIG on HBsAg and HBeAg are surrogate outcomes (raising risk of indirectness), and we need to be critical while interpreting the findings. We found no data on newborn mortality or maternal mortality or both, or other serious adverse events. Well-designed randomised clinical trials are needed to determine the benefits and harms of HBIG versus placebo in prevention of MTCT of HBV.
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Affiliation(s)
- Ahizechukwu C Eke
- Johns Hopkins University School of MedicineDivision of Maternal Fetal Medicine, Department of Gynecology and Obstetrics600 N Wolfe StreetPhipps 228BaltimoreMarylandUSA21287‐1228
| | - George U Eleje
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi CampusEffective Care Research Unit, Department of Obstetrics and GynaecologyPMB 5001, NnewiAnambra StateNigeria
| | - Uzoamaka A Eke
- University of Connecticut Health CenterDepartment of Infectious Diseases263 Farmington AvenueFarmingtonConnecticutUSA06053
| | - Yun Xia
- Beijing University of Chinese Medicine Subsidiary Dongfang HospitalScience of EducationNo.6 District 1 Fangxingyuan, Fangzhuang, Fengtai DistrictBeijingChina100078
| | - Jiao Liu
- Beijing University of Chinese Medicine Subsidiary Dongfang HospitalNo.6 District 1 Fangxingyuan, Fangzhuang, Fengtai DistrictBeijingChina100078
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Patel MK, Le Calvez E, Wannemuehler K, Ségalin JM. Hepatitis B Vaccination Coverage and Prevalence of Hepatitis B Surface Antigen Among Children in French Polynesia, 2014. Am J Trop Med Hyg 2016; 94:1370-5. [PMID: 27001757 DOI: 10.4269/ajtmh.15-0903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/12/2016] [Indexed: 01/18/2023] Open
Abstract
French Polynesia is considered to be moderately endemic for chronic hepatitis B virus infection, with an estimated 3% of the population having hepatitis B surface antigen (HBsAg). From 1990 to 1992, a 3-dose hepatitis B vaccination series was introduced into the routine infant immunization schedule in French Polynesia, including a birth dose (BD). In 2014, a nationally representative 2-stage cluster survey was undertaken to evaluate the impact of the vaccination program on HBsAg prevalence among school children (∼6 years of age) in Cours Préparatoire (CP). Documented vaccination data were reviewed for all eligible children; children with consent were tested for HBsAg with a rapid point-of-care test. In total, 1,660 students were identified; 1,567 (94%) had vaccination data for review and 1,196 (72%) participated in the serosurvey. Three-dose vaccination coverage was 98%, while timely BD coverage, defined as a dose administered within 24 hours of life, was 89%. Receipt of the second and third doses was often delayed, with 75% and 55% receiving a second and third dose within 1 month of the recommended age, respectively. No children tested positive for HBsAg. French Polynesia's vaccination program has achieved high coverage and an HBsAg seroprevalence of 0% (0-0.5%) among CP school children, but timeliness of vaccination could be improved.
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Affiliation(s)
- Minal K Patel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Bureau des Programmes de Pathologies Infectieuses, Direction de la Santé, Papeete, French Polynesia
| | - Evelyne Le Calvez
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Bureau des Programmes de Pathologies Infectieuses, Direction de la Santé, Papeete, French Polynesia
| | - Kathleen Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Bureau des Programmes de Pathologies Infectieuses, Direction de la Santé, Papeete, French Polynesia
| | - Jean-Marc Ségalin
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Bureau des Programmes de Pathologies Infectieuses, Direction de la Santé, Papeete, French Polynesia
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Jordan R, Law M. An appraisal of the efficacy and cost effectiveness of antenatal screening for hepatitis B. J Med Screen 1997; 4:117-27. [PMID: 9368867 DOI: 10.1177/096914139700400302] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this review published data are used to determine the benefits and costs of antenatal screening for hepatitis B carriers to prevent the later occurrence of hepatoma and chronic liver disease in their offspring. In Britain, babies born to carrier mothers have a 25% risk of perinatal infection and of becoming carriers themselves (the risk is 82% if their mothers are positive for the e antigen and 10% if negative). The carrier state increases the risk of hepatoma an estimated 86 times and the risk of chronic liver disease 20 times. Life table analysis showed that there is an 11% lifetime risk in carriers in Britain of dying from hepatoma (which results in seven years of life lost on average) and a 7% risk of chronic liver disease (14 years of life lost). Neonatal vaccination reduces the risk of the infant becoming a carrier by about 90%. Perinatal transmission occurs in 38 of every 100,000 neonates in Britain. Antenatal screening of all women and vaccinating babies of carrier mothers would prevent perinatal transmission in 34 of the 38 children (90%), or 255 per year in Britain. Of these 34, 8.4 children would be Chinese in ethnic origin, 4.2 African, 11.5 South Asian (from the Indian subcontinent), 2.0 Caribbean, and 7.3 would be white. Six deaths in the 34 from hepatoma or chronic liver disease caused by hepatitis B would then be prevented. The direct cost in Britain of screening all women, irrespective of ethnicity, at their first pregnancy only, would be 1300 pounds for each year of life saved (undiscounted) or 2500 pounds if screening at every pregnancy. Screening just Chinese, Africans, and South Asians, at first pregnancy only, would cost 330 pounds for each year of life saved but would prevent only 64% of these deaths. Vaccinating the infants of carrier mothers is likely also to prevent horizontal transmission of hepatitis B in early childhood and prevent the carrier state developing in an estimated three extra children for each child protected from vertical transmission. When this is taken into account the number of deaths prevented increases fourfold, reducing the cost for each year of life saved by 75%. Screening all women at first pregnancy only is an acceptably cost effective policy in Britain (1300 pounds for each year of life saved), actually preventing 45 deaths a year from hepatoma and chronic liver disease (or about 180 deaths if those horizontally infected are included), at a total cost of 540,000 pounds a year. It has the advantage of being comprehensive, equitable, and easier to implement than a policy based on screening of high risk ethnic groups.
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Affiliation(s)
- R Jordan
- Department of Environmental & Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's, London, United Kingdom
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Spiegel A, Boutin JP, Cartel JL, Chanteau S, Cardines R, Saliou P, Roux JF. One year evaluation of immunogenicity conferred by a Chinese hamster ovary cell recombinant hepatitis B vaccine in a French Polynesian newborn immunization programme. Trans R Soc Trop Med Hyg 1991; 85:783-7. [PMID: 1801354 DOI: 10.1016/0035-9203(91)90454-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In 1988, a hepatitis immunization programme, using a Chinese hamster ovary (CHO) cell recombinant vaccine, was implemented for newborn children in the Austral archipelago (French Polynesia). Three different schedules were used: (i) 4 vaccine doses at months (M) 0, M1, M2 and M12; (ii) 3 vaccine doses at M0, M1, M6; and (iii) 3 vaccine doses at M0, M1, M2. Results at the one year follow-up may be summarized as follows. Of 197 infants who received one or more doses of CHO-recombinant vaccine, (i) none was an HBsAg carrier; (ii) 89.5% had anti-HBs-antibody titres greater than 10 miu/ml; and (iii) 95.9% had seroconverted for at least one of the 2 antibodies studied (anti-HBs or anti-pre-S2). After 2 doses (M0, M1), anti-HBs seroconversion rate and geometric mean titre were, respectively, 82.6% and 98.47 miu/ml. After 3 doses, seroconversion rates and geometric mean titres were, respectively, 91.1% and 200.59 miu/ml using schedule M0, M1, M2, and 100% and 1253.4 miu/ml using the M0, M1, M6 schedule. None of the 7 vaccinated neonates born to HBsAg/HBeAg positive mothers was found to be an HBsAg carrier. These preliminary results indicate that, in field conditions, vaccination with a CHO-recombinant vaccine resulted in high immunogenicity.
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Affiliation(s)
- A Spiegel
- Institut Territorial de Recherches Médicales Louis Malardé, Papeete, Tahiti, French Polynesia
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