RESUMO
BACKGROUND: Until 2008, human rabies had never been reported in French Guiana. On 28 May 2008, the French National Reference Center for Rabies (Institut Pasteur, Paris) confirmed the rabies diagnosis, based on hemi-nested polymerase chain reaction on skin biopsy and saliva specimens from a Guianan, who had never travelled overseas and died in Cayenne after presenting clinically typical meningoencephalitis. METHODOLOGY/PRINCIPAL FINDINGS: Molecular typing of the virus identified a Lyssavirus (Rabies virus species), closely related to those circulating in hematophagous bats (mainly Desmodus rotundus) in Latin America. A multidisciplinary Crisis Unit was activated. Its objectives were to implement an epidemiological investigation and a veterinary survey, to provide control measures and establish a communications program. The origin of the contamination was not formally established, but was probably linked to a bat bite based on the virus type isolated. After confirming exposure of 90 persons, they were vaccinated against rabies: 42 from the case's entourage and 48 healthcare workers. To handle that emergence and the local population's increased demand to be vaccinated, a specific communications program was established using several media: television, newspaper, radio. CONCLUSION/SIGNIFICANCE: This episode, occurring in the context of a Department far from continental France, strongly affected the local population, healthcare workers and authorities, and the management team faced intense pressure. This observation confirms that the risk of contracting rabies in French Guiana is real, with consequences for population educational program, control measures, medical diagnosis and post-exposure prophylaxis.
Assuntos
Vírus da Raiva/isolamento & purificação , Raiva/diagnóstico , Raiva/epidemiologia , Animais , Quirópteros/virologia , Feminino , Guiana Francesa/epidemiologia , Pessoal de Saúde , Humanos , Masculino , Profilaxia Pós-Exposição/métodos , Raiva/prevenção & controle , Raiva/virologia , Vacina Antirrábica/administração & dosagem , Saliva/virologia , Pele/virologiaRESUMO
Analysis of the evolution of drug target genes under changing drug policy is needed to assist monitoring of Plasmodium falciparum drug resistance in the field. Here we genotype Pfcrt and Pfdmr1 of 700 isolates collected in French Guiana from 2000 (5 years after withdrawal of chloroquine) to 2008, i.e., the period when the artemether-lumefantrine combination was progressively introduced and mefloquine was abandoned. Gene sequencing showed fixation of the 7G8-type Pfcrt SMVNT resistance haplotype and near fixation of the NYCDY Pfdmr1 haplotype. Pfdmr1 gene copy number correlated with 50% inhibitory concentrations of mefloquine and halofantrine (r = 0.64 and 0.47, respectively, n = 547); its temporal changes paralleled changes in in vitro mefloquine susceptibility. However, the molecular parameters studied did not account for the regained in vitro susceptibility to chloroquine and showed a poor correlation with susceptibility to artemether, lumefantrine, or quinine. Identification of novel markers of resistance to these antimalarials is needed in this South American area.
Assuntos
Aminoquinolinas/uso terapêutico , Antimaláricos/uso terapêutico , Resistência a Medicamentos/genética , Malária Falciparum/tratamento farmacológico , Proteínas de Membrana Transportadoras/genética , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Plasmodium falciparum/genética , Proteínas de Protozoários/genética , Combinação Arteméter e Lumefantrina , Artemisininas/uso terapêutico , Cloroquina/administração & dosagem , Cloroquina/uso terapêutico , Combinação de Medicamentos , Etanolaminas/uso terapêutico , Evolução Molecular , Fluorenos/uso terapêutico , Guiana Francesa/epidemiologia , Dosagem de Genes , Haplótipos , Humanos , Concentração Inibidora 50 , Estudos Longitudinais , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Mefloquina/uso terapêutico , Testes de Sensibilidade Parasitária , Fenantrenos/uso terapêutico , Plasmodium falciparum/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Quinina/administração & dosagem , Quinina/uso terapêuticoRESUMO
On May 27, 2008, a patient died from rabies at the Cayenne Hospital in French Guiana. Postexposure prophylaxis vaccination was implemented for all health care workers exposed to this patient. Examining the management of such a rare risk reveals important factors in the education of personnel who may have contact with a patient with rabies, to permit appropriate risk assessment and reduce unnecessary postexposure prophylaxis, taking into account the risks and costs of adverse events.
Assuntos
Pessoal de Saúde , Exposição Ocupacional , Profilaxia Pós-Exposição/métodos , Vacina Antirrábica/administração & dosagem , Vacina Antirrábica/efeitos adversos , Raiva/prevenção & controle , Raiva/transmissão , Adulto , Guiana Francesa , Humanos , Masculino , Medição de RiscoRESUMO
We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998-2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel.
Assuntos
Quimioprevenção/métodos , Malária Falciparum/parasitologia , Malária Vivax/parasitologia , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Animais , Antimaláricos/administração & dosagem , Antimaláricos/uso terapêutico , Surtos de Doenças/prevenção & controle , Reservatórios de Doenças/parasitologia , Guiana Francesa/epidemiologia , Humanos , Incidência , Insetos Vetores/parasitologia , Estudos Longitudinais , Malária Falciparum/tratamento farmacológico , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , Malária Falciparum/transmissão , Malária Vivax/tratamento farmacológico , Malária Vivax/epidemiologia , Malária Vivax/prevenção & controle , Malária Vivax/transmissão , Militares , Plasmodium falciparum/efeitos dos fármacos , Plasmodium vivax/efeitos dos fármacosRESUMO
To perform epidemiological surveillance during deployments, the French military health service has developed a real-time surveillance approach. The objective was to identify the benefits and problems of this approach. A prototype of real-time surveillance has been set up in French Guiana since 2004. Its permanent evaluation has allowed identifying strengths and weaknesses. The experience has permitted expansion of the concept to French forces in Djibouti and also development of a global approach for the whole French armed forces. Real-time surveillance has shown its usefulness for early warning during different real and simulated situations. Functional and architectural choices have permitted interoperability with allied nations. However, the information produced was only the first step of the diagnostic epidemiological situation followed by other investigations. This first step of development has highlighted the required complementarity with traditional epidemiological surveillance.
Assuntos
Surtos de Doenças/prevenção & controle , Militares , Vigilância da População/métodos , Interpretação Estatística de Dados , França/epidemiologia , Guiana Francesa , HumanosRESUMO
BACKGROUND: A dengue fever outbreak occurred in the interior of French Guiana from November 2005 onwards. An investigation, with epidemiological, entomological and public health inputs, was initiated. Its objectives were to confirm the outbreak, to describe the emergence of dengue fever in the High Maroni area and to initiate a specific public health response. METHODS: The investigation was conducted in Maripasoula in February 2006, the biggest community in that part of the country. Definition criteria were used for suspected, probable and confirmed cases of dengue fever. An entomological evaluation for larvae and adult mosquitoes was carried out. Some personal and collective vector control measures were set up by the vector control team. RESULTS: This survey identified 127 suspected dengue fever cases, whereas the epidemiological surveillance system detected only six probable and confirmed cases from the same place and for the same period. The proportion of dengue fever was higher in those people who had not travelled (23.5%) than within the population that had travelled (15.3%) in the three previous months (P = 0.01). Larvae of Stegomyia aegypti were found throughout the town, and adults were captured in 90.9% of the houses. CONCLUSION: This is the first time that a dengue fever outbreak has been described beyond the coastal region of this French overseas Department.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Adulto , Animais , Culicidae/virologia , Dengue/diagnóstico , Dengue/etiologia , Dengue/transmissão , Feminino , Guiana Francesa/epidemiologia , Humanos , Masculino , Vigilância da População/métodosRESUMO
During a dengue-3 outbreak in Paraguay at the beginning of 2007, capillary blood samples absorbed onto filter papers were collected from 44 suspected cases. These samples were subjected to three molecular and serologic tests, and 31 of the 44 samples gave a positive result by at least one of the techniques used. Molecular analyses detected the dengue-3 serotype in 22 patients and additionally the dengue-2 serotype in two patients. Therefore two different serotypes were co-circulating during this outbreak. Overall, this study validates the use of dried-blood samples for field screening investigations. Indeed, all types of laboratory studies of dengue were possible with samples consisting of a few drops of dried blood from finger pricks.
Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Surtos de Doenças , Antígenos Virais/sangue , Dengue/sangue , Vírus da Dengue/classificação , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Papel , Paraguai/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response. METHODS: Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants. RESULTS: It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance. CONCLUSION: Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Militares , Vigilância da População/métodos , Dengue/diagnóstico , Dengue/prevenção & controle , Surtos de Doenças/prevenção & controle , Diagnóstico Precoce , Guiana Francesa/epidemiologia , Humanos , Medicina MilitarRESUMO
BACKGROUND: To evaluate a new military syndromic surveillance system (2SE FAG) set up in French Guiana. METHODS: The evaluation was made using the current framework published by the Centers for Disease Control and Prevention, Atlanta, USA. Two groups of system stakeholders, for data input and data analysis, were interviewed using semi-structured questionnaires to assess timeliness, data quality, acceptability, usefulness, stability, portability and flexibility of the system. Validity was assessed by comparing the syndromic system with the routine traditional weekly surveillance system. RESULTS: Qualitative data showed a degree of poor acceptability among people who have to enter data. Timeliness analysis showed excellent case processing time, hindered by delays in case reporting. Analysis of stability indicated a high level of technical problems. System flexibility was found to be high. Quantitative data analysis of validity indicated better agreement between syndromic and traditional surveillance when reporting on dengue fever cases as opposed to other diseases. CONCLUSIONS: The sophisticated technical design of 2SE FAG has resulted in a system which is able to carry out its role as an early warning system. Efforts must be concentrated on increasing its acceptance and use by people who have to enter data and decreasing the occurrence of the frequency of technical problems.