Guillaume Béraud

Severe ear chondritis due to cowpox virus transmitted by a pet rat

We describe a case of cowpox virus infection leading to severe acute inflammation and chondritis of the outer ear, complicated by local necrosis and facial cellulitis. Secondary lesions occurred on a finger and the abdomen. Apart from scarring, outcome was favorable after repeated surgical excision of necrotic tissue.

The French Connection : the first large population-based contact survey in France relevant for the spread of infectious diseases

Background Empirical social contact patterns are essential to understand the spread of infectious diseases. To date, no such data existed for France. Although infectious diseases are frequently seasonal, the temporal variation of contact patterns has not been documented hitherto. Methods COMES-F is the first French large-scale population survey, carried out over 3 different periods (February-March, April, April-May) with some participants common to the first and the last period. Participants described their contacts for 2 consecutive days, and reported separately on professional contacts when typically over 20 per day. Results 2033 participants reported 38 881 contacts (weighted median [first quartile-third quartile]: 8[5–14] per day), and 54 378 contacts with supplementary professional contacts (9[5–17]). Contrary to age, gender, household size, holidays, weekend and occupation, period of the year had little influence on the number of contacts or the mixing patterns. Contact patterns were highly assortative with age, irrespective of the location of the contact, and gender, with women having 8% more contacts than men. Although most contacts occurred at home and at school, the inclusion of professional contacts modified the structure of the mixing patterns. Holidays and weekends reduced dramatically the number of contacts, and as proxies for school closure, reduced R0 by 33% and 28%, respectively. Thus, school closures could have an important impact on the spread of close contact infections in France. Conclusions Despite no clear evidence for temporal variation, trends suggest that more studies are needed. Age and gender were found important determinants of the mixing patterns. Gender differences in mixing patterns might help explain gender differences in the epidemiology of infectious diseases.

Phenotyping chronic pulmonary aspergillosis by cluster analysis.

Chronic pulmonary aspergillosis (CPA) is a complex disorder involving various underlying conditions and risk factors, clinical and radiological features, and natural histories or responses to treatment [1]. Untreated, patients with CPA have ≥50% 5-year mortality [2, 3]. Recently, it was proposed that CPA includes simple aspergilloma, chronic cavitary pulmonary aspergillosis (CCPA) and chronic necrotising pulmonary aspergillosis (CNPA) [1]. Cluster analysis based on clinical and radiological settings does not distinguish any specific phenotype of CPA http://ow.ly/QZq7V

Lopinavir to atazanavir or darunavir switch in HIV-1-infected patients with dyslipidemia: an observational study

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Resurgence risk for measles, mumps and rubella in France in 2018 and 2020

Background Large measles and mumps outbreaks recently occurred throughout Europe and the United States. Aim: Our aim was to estimate and map the risk of resurgence for measles, mumps and rubella in France. Methods: We used a multi-cohort model combining seroprevalence information, vaccine coverage and social contact data. Results: The overall outbreak risk for France in 2018 was highest for mumps, remained significant for measles despite a recent measles outbreak and was low for rubella. Outbreak risks were heterogeneous between departments, as the effective reproduction numbers for 2018 ranged from 1.08 to 3.66. The seroprevalence, and therefore the risk of measles and rubella infection, differed significantly between males and females. There was a lower seroprevalence, and therefore a higher risk, for males. Infants of less than 1 year would be seriously affected in a future outbreak of measles, mumps or rubella, but the highest overall caseload contribution would come from teenagers and young adults (10–25 years old). Conclusions: The high risk for teenagers and young adults is of concern in view of their vulnerability to more severe measles, mumps and rubella disease and complications.

Modeling the impact of changes in day-care contact patterns on the dynamics of varicella transmission in France between 1991 and 2015

Annual incidence rates of varicella infection in the general population in France have been rather stable since 1991 when clinical surveillance started. Rates however show a statistically significant increase over time in children aged 0–3 years, and a decline in older individuals. A significant increase in day-care enrolment and structures’ capacity in France was also observed in the last decade. In this work we investigate the potential interplay between an increase of contacts of young children possibly caused by earlier socialization in the community and varicella transmission dynamics. To this aim, we develop an age-structured mathematical model, informed with historical demographic data and contact matrix estimates in the country, accounting for longitudinal linear increase of early childhood contacts. While the reported overall varicella incidence is well reproduced independently of mixing variations, age-specific empirical trends are better captured by accounting for an increase in contacts among pre-school children in the last decades. We found that the varicella data are consistent with a 30% increase in the number of contacts at day-care facilities, which would imply a 50% growth in the contribution of 0-3y old children to overall yearly infections in 1991–2015. Our findings suggest that an earlier exposure to pathogens due to changes in day-care contact patterns, represents a plausible explanation for the epidemiological patterns observed in France. Obtained results suggest that considering temporal changes in social factors in addition to demographic ones is critical to correctly interpret varicella transmission dynamics.

Legal framework of antimicrobial stewardship in hospitals (LEASH): a European Society of Clinical Microbiology and Infectious Diseases (ESCMID) cross-sectional international survey

Antimicrobial stewardship (AMS) is the cornerstone activity in the combat against antimicrobial resistance. In order to ensure sustainable deployment and development of AMS, a strategic and regulatory framework needs to be provided by national healthcare authorities. Experts from 32 European countries, Israel and Turkey were invited to participate in a cross-sectional internet-based survey from October 2016 to May 2017 on the legal framework and mandatory components (structures, activities) of AMS in hospitals, i.e. components required by legislation or regulations. We collected data from 25 countries and two regions (in countries with federal health administration). Laws regulating AMS existed in seven countries and one region. Other health ministry regulations were applicable in 13 countries and one region. National strategies and/or action plans approved by ministries of health were in place in 13 countries and one region. Conversely, five countries and one region had no regulation of AMS in hospitals. Funding for AMS in hospitals was provided in five countries and one region. Eight countries and one region reported mandatory AMS structures and activities complying with the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) structure, policy and practice indicators. In 10/27 cases, however, the mandatory AMS activities were not being fully carried out. The survey showed heterogeneous legal frameworks for AMS in hospitals, and in many countries it was even lacking. The situation may be critical in countries with poor control of antimicrobial use and resistance. Recent international initiatives calling on policy-makers to address the threat of antimicrobial resistance could yield improvement.

Mathematical models and vaccination strategies

Infection transmission is a complex and dynamic process, and is therefore difficult to assess. Consequently, mathematical models are a useful tool to understand any leverage on this transmission, such as vaccination. Models can provide guidance to implement an optimal vaccination campaign whether it concerns the fraction of the population or the age-group to be vaccinated. Mathematical models can also provide insights on counter-intuitive collateral effects of vaccination campaign, given the possibility that the overall benefits for the general population may hide deleterious effects on some sub-groups. As a large proportion of the population is now vaccinated, complex modelling taking into account individual and population heterogeneity and behaviour is necessary although challenging. But the most crucial aspect in the future of mathematical modelling still consists in obtaining precise and exhaustive data.

COL 2-03 - Le risque de résurgence de la rougeole, des oreillons et de la rubéole en France en 2016

Introduction L’épidémie de rougeole ayant touché la France en 2010-2011, attribuée à une couverture vaccinale insuffisante, représentait plus de la moitié des 30 000 cas européens. Des épidémies de rougeole et d’oreillons ont récemment eu lieu en Europe (e.g. Pays-Bas & Royaume-Uni). Le vaccin recommandé étant trivalent (ROR), un risque de résurgence de rougeole est associé à un risque d’épidémie d’oreillons et rubéole. Nous avons donc estimé et cartographié le risque de résurgence pour la rougeole, les oreillons et la rubéole en France. Matériels et méthodes Un modèle multi-cohortes a été développé où (1) les sérologies de la rougeole, des oreillons et de la rubéole ont été modélisées afin de prédire la susceptibilité à ces infections lors du recueil des données (2009 ou 2013) ; (2) la susceptibilité selon l’âge et le département a été dérivée pour l’année d’intérêt (2016) ; (3) l’incidence relative selon l’âge et le risque épidémique (taux de reproduction effectif) ont été calculés à l’aide de matrices de contact. Résultats Le risque d’épidémie en France en 2016 est élevée pour les oreillons, modérée pour la rougeole et négligeable pour la rubéole. Ce risque était hétérogène selon les départements, dont les plus à risque pour la rougeole, les oreillons et la rubéole étaient respectivement la Haute-Marne, le Cantal, et le Puy-de-Dôme. Les départements à risque étaient similaires pour les oreillons et la rubéole (Sud-est/Sud-Centre) tandis qu’ils étaient éparpillés pour la rougeole. La participation des enfants < 1 an à une éventuelle épidémie serait importante mais la plus grande contribution reviendrait aux adolescents et jeunes adultes (10-25 ans). Les vacances scolaires (comme modèle de fermetures d’écoles « préventives ») réduirait le taux de reproduction effective de 37.2 %, 29.5 %, et 33.4 % pour la rougeole, les oreillons et la rubéole respectivement. La susceptibilité de la rougeole et la rubéole – donc le risque épidémique – varie selon le genre, les hommes étant plus souvent susceptibles que les femmes, ce qui n’était pas le cas pour les oreillons. Conclusion Avec des données d’enquêtes sérologiques et de couverture vaccinale, nous avons montré qu’il persiste un risque pour une nouvelle épidémie de rougeole, malgré l’épidémie récente, mais le risque prédomine pour les oreillons. Le risque élevé pour les adolescents et les jeunes adultes est préoccupant, en raison du risque élevé de formes sévères et de complications à ces âges. Les différences de susceptibilité selon le genre soulèvent la question des campagnes de vaccinations adaptées au genre pour diminuer le risque de futures épidémies. Aucun lien d’intérêt