I Capek

European Bat Lyssavirus Transmission among Cats, Europe

We identified 2 cases of European bat lyssavirus subtype 1 transmission to domestic carnivores (cats) in France. Bat-to-cat transmission is suspected. Low amounts of virus antigen in cat brain made diagnosis difficult.

Chlamydial infections in duck farms associated with human cases of psittacosis in France.

Five severe cases of psittacosis in individuals associated with duck farms were notified in France between January and March 2006. Diagnostic examination included serology and/or molecular detection by PCR from respiratory samples. As a consequence, we investigated all duck flocks (n=11) that were housed in the three farms where human infections occurred. While serology by complement fixation test was negative for all samples, cloacal and/or tracheal chlamydial excretion was detected by PCR in all three units. Notably, one duck flock was tested strongly positive in 2 of the 3 affected farms, and Chlamydophila (C.) psittaci strains were isolated from cloacal and/or tracheal swab samples from both farms. Human samples and duck isolates exhibited the same PCR-RFLP restriction pattern, which appeared to be an intermediate between genotypes A and B. Analysis of ompA gene sequences and comparison to those of the type strains showed that the isolates could not be strictly assigned to any of the generally accepted genotypes of C. psittaci. Further analysis by MLVA of the PCR-positive human samples revealed two distinct patterns, which were related to previously isolated C. psittaci duck strains.

Risk Factors for Leptospirosis in Metropolitan France: Results of a National Case-Control Study, 1999–2000

Risk factors for leptospirosis in France were investigated to improve the vaccination program for this disease. Data from 90 hospitalized case patients and 169 matched control subjects were analyzed in a case-control study. Skin lesions, canoeing, contact with wild rodents, and country residence were independently associated with leptospirosis, emphasizing that leisure activity is a risk factor for this illness.

Introduction of SARS in France, March–April, 2003

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.

An outbreak of airborne tularaemia in France, August 2004.

Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p<10-8). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in Vend¨¦e, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dog¡¯s fur disseminated by the dog shaking itself.

An imported case of canine rabies in Aquitaine: investigation and management of the contacts at risk, August 2004-March 2005.

In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.

Psittacosis outbreak after participation in a bird fair, Western France, December 2008.

In December 2008, three hospitalized cases of suspected psittacosis infection were notified by respiratory disease clinicians from a local hospital to the Regional Epidemiology Unit of Pays de la Loire, France. They all had attended a bird fair. A retrospective cohort study was conducted among exhibitors and organizers to identify potential risk factors in relation to this fair. Environmental and veterinary investigations were implemented to trace potential sources of infection. We identified two confirmed, two probable and 44 possible cases among participants. The attack rate in exhibitors and organizers was 38% (33/86). The median incubation period was 11 days (range 6-22 days). Individuals located in two particular sectors of the showroom were found to be at double the risk of developing psittacosis (relative rate 2·1, 95% confidence interval 1·03-4·18) than those in other sectors. Pooled faecal samples of birds belonging to a possible case exhibitor tested positive for Chlamydiaceae by PCR. Ventilation conditions in the showroom were inadequate. This investigation allowed the formulation of recommendations to prevent psittacosis in bird exhibitions which are held weekly in France.

Can Mortality Data Provide Reliable Indicators for Creutzfeldt-Jakob Disease Surveillance? A Study in France from 2000 to 2008

Background: Surveillance of Creutzfeldt-Jakob disease (CJD) is still an important issue because of the variant CJD epidemic, which is in decline and also because of the emergence of novel forms of animal transmissible spongiform encephalopathy with zoonotic potential and the risk of nosocomial and blood transfusion-related transmission. Active surveillance has been implemented in most European countries and requires important human resources and funding. Here, we studied whether national mortality and morbidity statistics can be used as reliable indicators. Methods: CJD data collected by the French national CJD surveillance centre were compared with data registered in the national mortality statistics. Results: From 2000 to 2008, the two sources reported fairly similar numbers of CJD deaths. However, analysis of individual data showed important between-sources disagreement. Nearly 24% of CJD reported by the mortality register were false-positive diagnoses and 21.6% of the CJD cases diagnosed by the surveillance centre were not registered as CJD in the national mortality statistics. One out of 22 variant CJD cases was not reported as having any type of CJD in the mortality statistics. Conclusions:These findings raise doubt about the possibility of a reliable CJD surveillance only based on mortality data.

Preclinical sporadic Creutzfeldt-Jakob disease in French blood donors: an epidemiologic model-based study.

BACKGROUND: A recent case‐control study showed that transfusion recipients were at an increased risk of developing sporadic Creutzfeldt‐Jakob disease (sCJD), suggesting that blood donors with silent preclinical sCJD could transmit the sCJD agent. We therefore estimated the annual number of French blood donors expected to have preclinical sCJD at the time of donation.

Les risques infectieux alimentaires et les zoonoses vus par les Français et leur médecin

L’élaboration des campagnes d’éducation pour la santé, ciblées sur des publics spécifiques, repose habituellement sur la perception des risques par la population. Or, malgré les crises sanitaires récentes liées à l’alimentation (listériose, « vache folle »...), il existe peu de données sur la perception par la population générale et les professionnels de santé du risque infectieux alimentaire ou des zoonoses en France. Des travaux ponctuels ont été menés en France pour évaluer l’évolution de la perception d’un risque lié à la consommation de viande bovine pendant et après la « crise de la vache folle » [1]. Les baromètres santé de l’Institut national de prévention et d’éducation pour la santé (Inpes) [2] et de l’Institut de radioprotection et de sureté nucléaire (IRSN) [3] sont les seules enquêtes régulières comprenant un volet sur la perception du risque alimentaire global en population générale mais elles n’explorent pas le risque infectieux. À partir de l’enquête Nicolle, menée par l’Inpes et l’Institut de veille sanitaire en 2006, l’objectif de cette étude est de décrire les connaissances, les attitudes et les pratiques des Français et de leurs médecins vis-à-vis du risque infectieux alimentaire et zoonotique. 2. Matériel et méthode