A description of influenza-like illness (ILI) sentinel surveillance in Cambodia, 2006-2008

Influenza-Like Illness (ILI) sentinel surveillance was initiated by the Communicable Disease Control Department (CDC), Ministry of Health, Cambodia and its partners to evaluate the epidemiology of influenza and identify the circulating strains. The surveillance started in late 2006 in four sentinel sites. The objectives of this study were 1) to document the incidence of LI and confirmed influenza cases reported in the national surveillance system from 2006 to 2008, just after the system and the definition were revised, 2) to identify the strains of influenza virus, 3) to compare the major demographic and clinical characteristics between ILI patients having positive and negative tests for influenza virus. An ILI case was defined as having a fever of at least 38 degrees C (axillary), cough or sore throat. A total of 155,866 ILI cases were reported to the CDC from 4 sentinel sites in Cambodia from August 2006 to December 2008. Specimens were collected in 1.8%. Of these, 9.6% tested positive for influenza. Influenza was observed to occur mainly from August to December, with a clear seasonal peak in October, as shown in the data from 2008. A new case definition beginning in August 2008 resulted in a decrease in weekly RI reported cases (from an average of 1,474 cases to 54 cases) and the proportion of positive tests for influenza increased (5.3% vs 29.3%). Influenza and ILI are seasonal in Cambodia. A higher body temperature was used to define ILI, which improved the influenza positivity rates.

Safety and effectiveness of amphotericin B deoxycholate for the treatment of visceral leishmaniasis in Uganda

Between September 2003 and April 2004, the supply of antimonial drugs to Amudat Hospital, in north-eastern Uganda, was interrupted and all cases of visceral leishmaniasis presenting at the hospital could only be treated with amphotericin B deoxycholate (AmB). This allowed the safety and effectiveness of the AmB to be evaluated, in comparison with an historical cohort of patients treated, at the same hospital, with meglumine antimoniate (Sb(V)). Demographic and clinical data were collected before and after treatment. Adverse effects were recorded passively in all the subjects, and actively, using a standardized questionnaire, in a sub-group of the patients given AmB. The in hospital case-fatality 'rates' were 4.8% [95% confidence interval (CI) = 2.4%-8.8%] among the 210 patients treated with AmB and 3.7% (CI = 1.4%-7.9%) among the 161 patients treated with Sb(V) (P>0.20). Adverse effects requiring treatment interruption were rare in both cohorts. Treatment failures (i.e. non-responses or relapses) were observed in 2.9% (CI = 1.2%-6.4%) of the patients treated with AmB and 1.2% (CI = 0.1%-4.4%) of the patients treated with Sb(V) (P>0.20). For the treatment of visceral leishmaniasis in Uganda, AmB therefore had a similar effectiveness and safety profile to that of meglumine antimoniate.

Factors related to delayed diagnosis of HIV infection in southeastern France. EVALVIH group

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P<10(-2)) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening.

[Epidemiological surveillance of HIV-seropositive subjects identified in Provence-Alpes-Cote d'Azur in 1996-1997]

OBJECTIVE

The aim of this study was to assess trends in new HIV-positivities identified in the Provence-Alpes-Cote d'Azur area in southern France in 1996 and 1997 and to identify any weaknesses in the screening policy.

METHODS

Data were collected from the EVALVIH epidemiological surveillance system initiated in 1995. The data were obtained from both anonymous reports of medical biology laboratories and of prescribing physicians in the area.

RESULTS

From January 1996 to December 1997, 825 persons (67% men, 33% women) were found to be HIV-positive. Although the percentage of intravenous drug users (18%) and homo-bisexual individuals (23%) remained high, the proportion of heterosexuals was higher (45%). The number of identified cases of HIV seropositivity fell from 271 in the first semester 1996 to 137 in the second semester 1997, i.e. a 49% decline (p < 0.001). There was no significant difference in this trend for age, gender, transmission mode, or geographical origin of the subjects.

CONCLUSION

These results confirm the positive impact of the HIV prevention program in the Provence-Alpes-Cote d'Azur region and the insufficiencies of the screening policy requiring urgent reconsideration.

Factors related to the prescription of antibiotics for young children with viral pharyngitis by general practitioners and paediatricians in southeastern France

This study evaluates the antibiotic-prescribing practices of physicians as well as other related issues in the context of viral pharyngitis. In a telephone interview, 535 physicians practising in southeastern France were submitted a clinical case description of an episode of acute pharyngitis in a 2-year-old child. Questions concerned antibiotic treatment and physicians' reasons for their treatment decision. The viral origin of the pharyngitis was more likely to be suspected by paediatricians than by general practitioners (92% vs. 78%, P<0.01); 57% of allopaths (compared with 26% of homeopaths/acupuncturists and 14% of paediatricians, P<0.001) declared they would prescribe an antibiotic in this situation (amoxicillin only in 42% of cases). This difference between allopaths and other physicians was still significant after controlling for knowledge regarding antibiotic therapy. In order to limit the risk of emerging resistant bacteria, it is urgent that training be upgraded for physicians, especially for allopaths.

[Nasopharyngeal carriage of resistance pneumococci in day-care centers in the Alps-Maritimes region]

To provide ongoing information on regional trends of antibiotic resistance prevalence to pneumococci, a cross selectional survey was conducted on a large representative sample of children attending day-care centers. Children were analyzed in spring (n = 378) and autumn (n = 379) for nasopharyngeal carriage. Streptococcus pneumoniae was detected in 149 children (39.4%) in Spring and 204 (59.8%) in Autumn. Half of these isolated strains showed penicillin insensitivity or resistance. A high proportion of children (43.6% in spring and 47.5% in autumn) had been treated with antibiotics during the 3 months prior to sample collection; 21.6% of isolated strains were serotype 6B, 20.1% type 23F, 18.9% type 19A and 19F, 11.5% type 14. Reduced susceptibility was frequently noted in serotype 23F, 14 and 19F, representing 93%, 94% and 46% of identified serotypes, respectively. Acquisition of a strain of PRP was correlated with prescription of antibiotics during the previous three months (p < 0.05). This type of survey on children in day-care centers can contribute to the understanding of regional variations in antibiotic resistance and provide information for epidemiological surveillance.

[The epidemiology of trench fever: a pilot study in homeless people in Marseilles]

Trench fever, cause by Bartonella quintana, disappeared decades ago. Between 1992 and 1994 about 20 cases were reported in industrialized countries [6, 7]. Some of these cases were associated with HIV infection [5], but most affected the homeless. The epidemiology of B. quintana is unknown in Europe, but infection and transmission are favoured by poor housing and hygiene. This paper describes the results of a seroprevalence survey among the homeless living in Marseille. The eight major non-profit organizations caring for the homeless in the city participated for the four winter months. Four of these organizations also provide health care. Each subject who came to be housed for more than one day were asked to complete a questionnaire and give a small blood sample by micropuncture. They were clearly informed about the aims of the research and were allowed to refuse participation freely. All blood samples were tested by the WHO collaborative center for ricketssiae using a previously tested and validated immunofluorescence technique. The subjects were scored positive if the IgG titer was above 1/100. Two hundred and twenty one subjects agreed to participate in the study. Most were of French origin (51.4%) and 40% under 40 years old. The seroprevalence was 1.8% (IC 95%: 0.05-3.55). None of the four positive subjects presented symptoms and clinical examination was normal. All four were over 40 years old; two were of French origin, 1 from Algeria and 1 from the Comoro Islands. One had an IgG titer above 1/3, 200, possibly reflecting recent contamination and/or severe infection. Statistical analysis revealed no significant association between seropositivity and housing or hygiene conditions. No socio-demographic data are available about the homeless in Marseille and indeed, there is no list of such individuals. It is therefore not possible to estimate the representativity of our sample. Nevertheless, we show that the homeless include infected individuals. Physicians who care for such subjects should prescribe B. quintana serological investigations, and organizations that take in these people should implement preventive action and health education programs. Any such policy must be designed so as to be acceptable to homeless people. This work should also encourage public health professionals to investigate more extensively infectious diseases among the homeless.