René Migliani

Epidemiological trends for human plague in Madagascar during the second half of the 20th century: a survey of 20 900 notified cases

Objectives  To describe the principal characteristics and epidemiological trends for human plague in modern times based on the largest reported series of cases from the highly active Malagasy focus.

Coexistence of Urogenital Schistosomiasis and Sexually Transmitted Infection in Women and Men Living in an Area Where Schistosoma haematobium is Endemic

BACKGROUND In settings in which adequate laboratory service is lacking, the coexistence of urogenital schistosomiasis and sexually transmitted infections (STIs) poses a diagnostic challenge for health care providers in the management of patients with urogenital complaints. METHODS Symptoms were recorded with use of a semistructured questionnaire at baseline and in follow-up surveys after STI and Schistosoma haematobium infection had been assessed and systematically treated as part of a community-based study of 253 women and 236 men, aged 15-49 years, living in an area of Madagascar where S. haematobium is endemic. RESULTS Of those infected with S. haematobium, 35% of the women had concordant STI (e.g., infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and/or Trichomonas vaginalis), compared with 17% of the men. Both S. haematobium infection and STI were significantly more common among younger individuals, aged 15-24 years, than among older individuals. A broad spectrum of urogenital symptoms was reported. However, one-half of the women and men who had positive test results for an STI or for S. haematobium infection were asymptomatic. Gross hematuria and dysuria were, in multivariate analysis, associated with S. haematobium infection, as were genitopelvic discomfort in women and ejaculation pain in men. The association became stronger with higher intensity of infection. In bivariate analysis but not in the multiregression model, STI was associated with vaginal discharge and genitopelvic discomfort in women and was associated with urethral discharge in men. CONCLUSIONS The rationale for empirical antischistosoma treatment of adolescents and younger adults in areas where S. haematobium is endemic, with praziquantel alone or in combination with existing anti-STI regimens, is discussed.

Methicillin-susceptible, Doxycycline-resistant Staphylococcus aureus, Côte d’Ivoire

This virulent clone has already spread to other continents.

Sexually transmitted infections in rural Madagascar at an early stage of the HIV epidemic. A 6-month community-based follow-up study.

Background and Objectives: Sexually transmitted infections (STIs) in Madagascar have primarily been monitored in selected groups of patients attending STI clinics in major cities as part of the HIV surveillance program in Madagascar. Goal of the Study: The aim of the study was to provide complementary data related to STI prevalence in a general rural population. Study Design: STIs were investigated in 643 subjects aged 15 to 49 years as part of a cross-sectional morbidity study of urogenital schistosomiasis. Infection rates were reassessed 3 weeks and 6 months after systematic STI treatment at baseline. Results: Neisseria gonorrhoeae (Ng), Chlamydia trachomatis (Ct), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv), and/or antibodies to Treponema pallidum (Tp) were diagnosed in 125 (37.5%) of 333 women and in 83 (26.8%) of 310 men. In addition, 49% of the women and 28% of the men were infected with herpes simplex virus-2. Six (0.9%) subjects were found HIV-antibody positive. Between the 3-week and 6-month follow-up surveys Ng, Ct, and/or Mg prevalence increased most prominently in women aged 15 to 24 years. Conclusion: Study findings suggest that rural areas in Madagascar should be as closely monitored and assisted in STI and HIV control as their urban counterparts. Following the current consensus, young adults should constitute a priority target group in the control programs.

High Prevalence of Hepatitis B Virus Genotype E in Northern Madagascar Indicates a West-African Lineage

The prevalence of hepatitis B virus (HBV) markers was investigated in 563 inhabitants aged 15–55 years from a sugar cane region, Sirama, and from a village, Mataipako, in Northern Madagascar. Serological markers of past or present infection were significantly higher in Sirama, 74% versus 45%. There was no difference in the prevalence of chronic HBsAg carriers, 8.7% versus 8.5% between the two regions. Sequencing the S gene in 45 strains revealed a predominance of genotype E, in 53%, followed by subgenotype A1 in 22%, and genotype D in 18%. Phylogenetic analyses of the genotype E strains showed homology with West African strains. All A1 isolates were similar to Malawi strains. Most genotype D strains were subgenotype D7 and related to strains from Somalia and Tunisia. One genotype D strain formed a branch between Pacific D4 and African D7 strains at neighbor‐joining analysis. The pre‐core stop mutant was found in 33% of the genotype D strains, 17% of E but not in any A1 strain. The high prevalence and low variability of genotype E strains in only two villages, indicates a rather recent introduction of this genotype into Madagascar from West Africa, possibly through migration or slave trade. The wider spread and genetic relationship of genotype D with East African and Austronesian strains indicate an earlier introduction of this genotype. Molecular epidemiology of HBV may thus be used to complement linguistic and genetic studies on past human migrations in Africa. J. Med. Virol. 82:1515–1526, 2010.

Sexual behavior and sexually transmitted infections in men living in rural Madagascar: implications for HIV transmission.

Background Madagascar is in the midst of a large HIV epidemic. Therefore, it is important to obtain relevant epidemiologic data that can be used to develop a preventive strategy. Goal The goal of the study was to assess sexual behavior and sexually transmitted infections (STIs) among men living in two coastal villages and one highland village with different levels of endemicity of urogenital schistosomiasis. Study Design Data were obtained from cross-sectional studies on male reproductive health. All men aged 15 to 49 years were offered enrollment. Results Of 401 men evaluated, 6.5% had used a condom and 45.6% reported having multiple partners in the previous 3 months. Symptoms of urethritis during the previous 7 days were reported by 128 men (31.9%). Urethritis was associated with the youngest age group (15–19 years) and the coastal villages, in which HIV antibodies were found in 0.9% and 2.5%, respectively. The prevalence of Schistosoma hematobium was 31.0% and 55.0% in these two villages, whereas none of the men in the highland village were infected. In bivariate analyses, urogenital schistosomiasis was associated with reported symptoms of urethritis, but it acted as a confounder in multivariate analyses. Conclusion Several risk factors for HIV propagation exist in these rural areas in Madagascar. Young men in particular should be targeted for HIV/STI prevention. Treatment of urogenital schistosomiasis could be considered part of the syndromic STI treatment in areas where S hematobium is endemic, for patients seeking primary care for urethritis.

Plasmodium vivax Malaria among Military Personnel, French Guiana, 1998–2008

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.

A Cluster of Acute Diarrhea Suspected to Be Cholera in French Travelers in Haiti, December 2010

A cluster of 21 cases of watery diarrhea suspected to be cholera that involved French military policemen and young volunteers occurring in the context of the Haiti cholera outbreak is described. The attack rate (AR) was higher among young volunteers (71.4%) than among policemen (15.3%) (p < 0.0001). There was a significant association between raw vegetables consumption and watery diarrhea in the young volunteer group. If we consider the raw vegetables consumers only, AR was lower among doxycycline-exposed subjects (relative risk: 0.2; 95% confidence interval: 0.1-0.4). The main aspect that is of scientific interest is the potential prophylactic effect of doxycycline used for malaria prophylaxis on the watery diarrhea AR.

Mass vaccination campaigns to eradicate poliomyelitis in Madagascar: oral poliovirus vaccine increased immunity of children who missed routine programme

To assess the impact of mass vaccination campaigns using oral poliovirus vaccine (OPV) in Madagascar, serum neutralizing antibodies and geometrical mean titres (GMTs) to poliovirus were measured among 472 children aged up to 59 months, before and after the mass campaign, regardless of their previous history of routine vaccination. In this study, overall coverage with three routine and two mass campaign OPV doses was 69.9 and 93.4%, respectively. Seroprevalences to all poliovirus types were significantly higher after the mass campaign among the children who were not vaccinated through routine programme: 67.5% vs. 90.2% (P < 0.001) for type 1; 66.7% vs. 95.1% (P < 0.001) for type 2; and 55.3% vs. 82.9% (P < 0.001) for type 3. Geometrical mean titres to all poliovirus types also significantly increased after the mass campaign among the same study group: 34.5 vs. 238.9 (P < 0.001) for type 1; 35.1 vs. 402.6 (P < 0.001) for type 2; and 13.3 vs. 92.6 (P < 0.001) for type 3. Post‐mass campaign seroprevalences and GMTs for poliovirus, especially types 1 and 3, among children who received up to two routine and two mass campaign OPV doses were significantly higher than pre‐mass campaign seroprevalences among children who received three routine OPV doses. Reasons for lack of adherence to the vaccination programme and the mass campaign are discussed. The findings strongly support the WHO strategy of conducting mass campaign in all endemic countries. However, as the mass campaign strategy now has been discontinued, it is crucial to increase the routine coverage and to improve acute flaccid paralysis surveillance in order to fulfil the goal of poliomyelitis eradication.

An approach for assessing effectiveness of a vaccination campaign against pertussis among young adults: The example of the French armed forces (2007–2012)

In 2011, we reported in this journal data arising from the surveillance of pertussis in the French armed forces from 2007 to 2009 and showed results consistent with the hypothesis of a shift of pertussis to young adults. Since military personnel are highly exposed due to their collective lifestyle, the military vaccination schedule was modified in 2008 according to national recommendations: A booster dose of inactivated diphtheria-tetanus-poliovirus vaccine combined with acellular pertussis vaccine (dTapIPV) was recommended in replacement of the usual dTIPV booster dose for military personnel who had not been vaccinated against pertussis in the previous 10 years. The aim of this work was to complete our previous analyses by adding the data from the period 2010e2012, to evaluate an eventual impact of these vaccination measures on the rates for pertussis in the French armed forces. The military epidemiological surveillance system covers all active duty personnel. The criteria for notification of pertussis include several case-definition parameters: