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Immigrants et tuberculose : données épidémiologiques récentes

Immigrants, and especially those recently arrived in host countries, are a high-risk group for tuberculosis. In 2006 in France, nearly half of the new cases of tuberculosis were reported in this group. The incidence rate among people born abroad was about seven times higher than that observed in people born in France (38.9/10(5) vs 5.2/10(5)). The incidence was also the highest in districts with a high proportion of socioeconomically vulnerable population, such as Paris and greater Paris area. The characteristics of French born and non-French born cases differed. Patients born abroad were less likely to have pulmonary tuberculosis (68.2% vs 78.2; p<0.001) and were more likely to live in institutions (such as migrant shelters) and to harbor multiresistant tuberculosis strains. A national tuberculosis control program was launched in France in 2007, to decrease the prevalence of tuberculosis in targeted populations.

Burden of infant bronchiolitis: data from a hospital network

In France, surveillance of bronchiolitis is based on a pilot network of hospital emergency departments. The study was a 1-year observational study (2007-2008) carried out in a central region of metropolitan France. The hospitalization rate for bronchiolitis was 17.7/1000 children aged <1 year and the estimated prevalence of bronchiolitis ranged from 17.7% to 34.4% in children aged <1 year. Such a network constitutes a valuable tool to estimate the dynamic and the burden of infant bronchiolitis.

L’alerte dans la surveillance actuelle des maladies infectieuses

Resume Les maladies infectieuses sont chaque annees en France responsables d’une morbidite et d’une mortalite importante. La surveillance de ces maladies doit fournir des informations permettant d’ameliorer nos connaissances sur leur epidemiologie (dynamique temporo-spatiale, evolution des caracteristiques cliniques et microbiologiques), afin de mettre en place des mesures de controle et de prevention adaptees, mais aussi permettre de detecter la survenue de tout phenomene nouveau ou anormal (epidemie, apparition d’un nouveau syndrome, resurgence d’une pathologie…). En France, cette surveillance repose actuellement sur le partenariat de multiples acteurs de sante publics et prives (medecins, biologistes, reseaux, laboratoires…). L’action de ces differents partenaires est en grande partie coordonnee par l’institut de veille sanitaire, dont la mission est de surveiller en permanence l’etat de sante de la population francaise et d’alerter les pouvoirs publics sur les menaces de sante publique. Cet article rappelle les objectifs et les modalites de la surveillance des maladies infectieuses en France en decrivant les principaux systemes et intervenants. La notion d’alerte est definie et les differentes situations d’alerte envisageables sont decrites a l’aide d’exemples recents. Dans le contexte tres dynamique de l’evolution epidemiologique des maladies infectieuses, il est necessaire de disposer d’outils adaptes et reactifs afin d’identifier au plus tot les menaces infectieuses pour la sante publique. Il convient egalement de disposer d’une recherche appliquee permettant de mieux apprehender la genese de ces phenomenes.

Factors associated with excessively lengthy treatment of tuberculosis in the eastern Paris region of France in 2004.

BackgroundFew data are available on prescriber adherence to tuberculosis (TB) treatment guidelines. In particular, excessively long treatment carries a risk of avoidable adverse effects and represents a waste of healthcare resources. We examined factors potentially associated with excessively long treatment.MethodsWe reviewed the medical records of patients diagnosed with TB in 2004 in the eastern Paris region. Sociodemographic and clinical factors associated with excessively long treatment were identified by logistic regression analyses. Based on contemporary guidelines, excessively long treatment was defined as more than 6 months of a four-drug regimen for thoracic TB with full sensitive strains, and more than 12 months for patients with extrathoracic TB.ResultsAnalyses concerned 478 patients with a median age of 36.0 ± 13.5 years, of whom 48% were living in precarious conditions (i.e. poor living conditions and/or no health insurance), 80% were born abroad, and 17% were HIV-seropositive. TB was restricted to the chest in 279 patients (isolated pulmonary, pleuropulmonary, and isolated pleural TB in 245, 13, and 21 patients, respectively), exclusively extrathoracic in 115 patients, and mixed in the remaining 84 patients. Treatment was prescribed by a chest specialist in 211 cases (44.1%) and 295 patients (61.7%) were managed in a single institution. The treatment duration complied with contemporary guidelines in 316 cases (66.1%) and was excessively long in 162 cases (33.9%). The median duration of excessively long treatment was 313 days (IQR: 272-412). In multivariate analysis, isolated thoracic TB, previous TB, HIV infection, a prescriber other than a chest specialist, and management in more than one healthcare center during treatment were independently associated with excessively lengthy treatment.ConclusionOne-third of TB patients received excessively long treatment, reflecting inadequate awareness of management guidelines or unwillingness to implement them.

Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information

OBJECTIVE In France, tuberculosis surveillance is based on mandatory notification (MN) of cases. However, the MN does not allow the full description of cases, and underreporting limits data interpretation. Aiming at better describing the cases of tuberculosis, the hospital record database (PMSI) was analyzed. PATIENTS AND METHOD Incident cases of active pulmonary tuberculosis identified in 2010 in France in the PMSI were included and their characteristics were compared with those of the cases identified through the MN. RESULTS In 2010, 5158 incident cases of pulmonary tuberculosis were identified in the PMSI. The mean duration of hospitalization was higher for cases considered contagious — at least one positive test result on pulmonary sample — (22 vs 13 days, P < 0.001). Among all cases, 5% were infected by HIV. Death was reported for 4% of cases. The number of pulmonary TB cases reported in the MN was 3781 in 2010. PMSI data by sex, region of residence and month of diagnosis were similar with those of the MN but patients were older in the PMSI (52 vs 47 years, P < 0.001). Considering the PMSI as exhaustive, sensitivity of the MN was estimated at 73.3% in 2010. CONCLUSION PMSI data were compatible with those of the MN and the estimation of the sensitivity was close to other French studies. PMSI can be considered as an interesting tool aiming at improving our knowledge about tuberculosis (TB) cases and strengthening awareness where the sensitivity of the MN is low.

Decrease in the incidence of culture-positive meningitis and cerebral tuberculomas in France from 1990 to 2007

We evaluated the incidence rate of culture-positive central nervous system tuberculosis (CNS TB) in France in 2007 and its time trend between 1990 and 2007. We used a capture-recapture analysis by using data recorded in 2007 by the mandatory notification system and the national network of the National Reference Centre (NRC). The 2007 sensitivity of the NRC was 79·4%. The previous sensitivity for 2000 (75·6%) and that for 2007 yielded a pooled estimate of 77·4% (95% confidence interval 64·8-88·0), which was used to extrapolate the number of culture-positive CNS TB cases from those reported in four surveys (1990, 1995, 2000, 2007). The extrapolated number of culture-positive CNS TB cases fell from 90 to 35 between 1990 and 2007, and the extrapolated incidence rates fell from 1·6 to 0·55 cases/million (P < 0·001). This favourable trend should be closely monitored following the change of the BCG vaccination policy in 2007.