Michel Setbon

The normalization of AIDS in Western European countries

The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

Factors in vaccination intention against the pandemic influenza A/H1N1

Abstract Background: Vaccination against pandemic influenza A/H1N1 is an effective strategy to mitigate the spread of the disease. While the vaccine is now available, social acceptance remains relatively uncertain in many societies. The purpose of this study was to examine the beliefs, attitudes and practices associated with the intention to get vaccinated against the A/H1N1 virus among the general population in France. Methods: A representative sample of 1001 individuals (stratified random recruitment procedure, ages 16–90 years) was interviewed by telephone. The questionnaire included a variety of items associated with socio-demographic characteristics, risk perceptions, illness perceptions, political attitudes and worldviews as well as intention to get vaccinated. Results: More than 6 out of 10 of the respondents indicated that they planned to get vaccinated when the vaccine becomes available. The same proportion of parents also reported the intention to vaccinate their children against the disease. In multiple regression analyses, socio-cognitive factors consistently predicting influenza A/H1N1 vaccination were: level of worry, risk perception and previous experience of vaccine against seasonal flu. Conclusions: The factors found to predict vaccination intention and their distribution are assumed to be a consequence of the fact that people perceive the risk of swine flu to be similar to that of seasonal flu. As a result, in the absence of an increase of the risk perception of pandemic influenza A/H1N1, a very low level of actual vaccination is forecasted. Behavioural change would require that the risks and consequences of pandemic influenza A/H1N1 be perceived as highly different from seasonal flu.

The 2009 pandemic H1N1 influenza vaccination in France: who accepted to receive the vaccine and why?

Introduction: Previous studies investigating determinants of 2009 (H1N1) pandemic influenza vaccine acceptance have focused on target groups such as healthcare workers. Few studies in the European Union have examined the self-reported reasons as well as predictive socio-demographic and health factors for pandemic influenza vaccine acceptance in the general population, even though influenza vaccine was recommended for all people. Methods: A nationwide telephone survey was conducted in France during the peak of the outbreak that occurred in December 2009 in adults (≥ 16 years), using a proportional random-digit dialing. Results: Interviews were completed by 1003 individuals, of whom 275 (27.4%) either had received pandemic influenza vaccine during the last weeks or intended to get vaccinated in the next weeks. Acceptance rates of pandemic vaccine were significantly higher among men, more educated and wealthier people, as well as persons who had a prior experience of influenza vaccination. The patterns of self-reported reasons for vaccine acceptance could be broadly divided into 3 groups related to (1) the mental representation of the threat – in particular the beliefs associated with the severity and personal vulnerability to the illness, (2) the perception of efficacy and safety of the vaccine, and (3) trust/distrust toward those advocating the vaccine. Conclusions: This national study indicates that social and cognitive determinants of pandemic influenza vaccine acceptance among French adults were relatively similar to those identified by previous studies of acceptance of seasonal influenza vaccine.

The rising impact of mathematical modelling in epidemiology : antibiotic resistance research as a case study

Mathematical modelling of infectious diseases has gradually become part of public health decision-making in recent years. However, the developing status of modelling in epidemiology and its relationship with other relevant scientific approaches have never been assessed quantitatively. Herein, using antibiotic resistance as a case study, 60 published models were analysed. Their interactions with other scientific fields are reported and their citation impact evaluated, as well as temporal trends. The yearly number of antibiotic resistance modelling publications increased significantly between 1990 and 2006. This rise cannot be explained by the surge of interest in resistance phenomena alone. Moreover, modelling articles are, on average, among the most frequently cited third of articles from the journal in which they were published. The results of this analysis, which might be applicable to other emerging public health problems, demonstrate the growing interest in mathematical modelling approaches to evaluate antibiotic resistance.

Lay perceptions of the pandemic influenza threat

A national survey on the public perception of the pandemic threat was conducted in France during the summer of 2008. Although the majority of the respondents displayed beliefs and attitudes toward the pandemic threat that could be considered as adaptive in the face of an outbreak, our results suggest that there are identifiable needs for public information about the transmission and prevention of the disease.

Population response to the risk of vector-borne diseases: lessons learned from socio-behavioural research during large-scale outbreaks

Vector-borne infectious diseases, such as malaria, dengue, chikungunya, and West Nile fevers are increasingly identified as major global human health threats in developing and developed countries. The success or failure of vector control rests mainly on the nature and scale of the behavioural response of exposed populations. Large-scale adoption of recommended protective behaviour represents a critical challenge that cannot be addressed without a better understanding of how individuals perceive and react to the risk of infection. Recently, French overseas territories faced large-scale outbreaks: an epidemic of chikungunya fever in La Re′ union and Mayotte (2005–2006) and four successive outbreaks of dengue fever in one Caribbean island, Martinique (1995–2007). To assess how these populations perceived and responded to the risk, and how the nature and scale of protection affected their clinical status, socio-epidemiological surveys were conducted on each island during the outbreaks. These surveys address three crucial and interconnected questions relevant to the period after persons infected by the virus were identified: which factors shape the risk of acquiring disease? Which socio- demographic characteristics and living conditions induce a higher likelihood of infection? What is the impact of risk perception on protective behaviours adopted against mosquito bites? Grounded on the results of these surveys, a general framework is proposed to help draw out the knowledge needed to reveal the factors associated with higher probability of infection as an outbreak emerges. The lessons learnt can inform health authorities’ efforts to improve risk communication programmes, both in terms of the target and content of messages, so as to explore new strategies for ensuring sustainable protective behaviour. The authors compare three epidemics of vector-borne diseases to elucidate psychosocial factors that determine how populations perceive and respond to the risk of infectious disease.

Healthcare worker compliance with seasonal and pandemic influenza vaccination.

Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well‐being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi‐pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

Integrative study of pandemic A/H1N1 influenza infections: design and methods of the CoPanFlu-France cohort

BackgroundThe risk of influenza infection depends on biological characteristics, individual or collective behaviors and the environmental context. The Cohorts for Pandemic Influenza (CoPanFlu) France study was set up in 2009 after the identification of the novel swine-origin A/H1N1 pandemic influenza virus. This cohort of 601 households (1450 subjects) representative for the general population aims at using an integrative approach to study the risk and characteristics of influenza infection as a complex combination of data collected from questionnaires regarding sociodemographic, medical, behavioral characteristics of subjects and indoor environment, using biological samples or environmental databases.Methods/DesignHouseholds were included between December 2009 and July 2010. The design of this study relies on systematic follow-up visits between influenza seasons and additional visits during influenza seasons, when an influenza-like illness is detected in a household via an active surveillance system. During systematic visits, a nurse collects individual and environmental data on questionnaires and obtains blood samples from all members of the household. When an influenza-like-illness is detected, a nurse visits the household three times during the 12 following days, and collects data on questionnaires regarding exposure and symptoms, and biological samples (including nasal swabs) from all subjects in the household. The end of the follow-up period is expected in fall 2012.DiscussionThe large amount of data collected throughout the follow-up will permit a multidisciplinary study of influenza infections. Additional data is being collected and analyzed in this ongoing cohort. The longitudinal analysis of these households will permit integrative analyses of complex phenomena such as individual, collective and environmental risk factors of infection, routes of transmission, or determinants of the immune response to infection or vaccination.

Scientist and public responses to BSE‐related risk: A comparative study

Social studies of risk repeatedly have found substantial divergences in the way that experts/scientists and members of the general public appraise risks associated with health and environmental hazards. However, empirical evidence for these differences remains controversial. A recent review of literature suggests in particular that divergences between experts and lay people may potentially result from confounding socio‐demographic factors. The purpose of the present article is to investigate and to compare how medical scientists and members of the general population reacted to BSE (“mad cow disease”) in France. A sample of 401 scientists belonging to the French Institute of Health and Medical Research (INSERM) and a representative sample of 902 French citizens were asked about their cognitive, affective and behavioural responses to BSE. Results show that non‐scientists tended to express much more concern about BSE‐related risk than scientists, even when socio‐demographic variables were controlled. However, (1) no significant differences were found between these two groups concerning subjective epidemiological predictions, and (2) scientists manifested greater avoidance of beef or beef by‐products avoidance following the BSE epidemic than lay respondents did. The implications of these paradoxical results are discussed.

Perceptions et comportements de prévention face à la dengue en Martinique

La dengue, arbovirose transmise par le moustique Aedes aegypti est présente dans les départements français d’Amérique (DFA) depuis la fin des années 1970. Cette pathologie y connaît depuis 1995 une double évolution : d’une part, une explosion du nombre de cas sous forme de pics épidémiques saisonniers suivis de périodes endémiques et d’autre part, un changement virologique à travers l’émergence de nouveaux sérotypes (4 à ce jour) dont certains apparaissent liés à la multiplication de nouvelles formes cliniques graves, telle la dengue hémorragique (Fig. 1). La lutte contre le moustique, collective et individuelle, qui vise à prévenir des piqûres de moustique est ainsi devenue un enjeu sanitaire d’autant plus important qu’il est le seul moyen capable d’en réduire l’incidence. L’identification de son impact sur la probabilité de contamination dans la population de la Martinique et des facteurs subjectifs et objectifs qui la déterminent apparaît ainsi comme un préalable essentiel pour orienter l’action publique et les campagnes de communication en direction de la population exposée. Une enquête socio-épidémiologique a été conçue, réalisée et analysée dans cette perspective en 2007 en Martinique. 1. Objectifs et méthode de l’enquête