RESUMEN
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.
Asunto(s)
Quimioprevención/métodos , Malaria Falciparum/parasitología , Malaria Vivax/parasitología , Plasmodium falciparum/fisiología , Plasmodium vivax/fisiología , Animales , Antimaláricos/administración & dosificación , Antimaláricos/uso terapéutico , Brotes de Enfermedades/prevención & control , Reservorios de Enfermedades/parasitología , Guyana Francesa/epidemiología , Humanos , Incidencia , Insectos Vectores/parasitología , Estudios Longitudinales , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Malaria Falciparum/transmisión , Malaria Vivax/tratamiento farmacológico , Malaria Vivax/epidemiología , Malaria Vivax/prevención & control , Malaria Vivax/transmisión , Personal Militar , Plasmodium falciparum/efectos de los fármacos , Plasmodium vivax/efectos de los fármacosRESUMEN
To perform epidemiological surveillance during deployments, the French military health service has developed a real-time surveillance approach. The objective was to identify the benefits and problems of this approach. A prototype of real-time surveillance has been set up in French Guiana since 2004. Its permanent evaluation has allowed identifying strengths and weaknesses. The experience has permitted expansion of the concept to French forces in Djibouti and also development of a global approach for the whole French armed forces. Real-time surveillance has shown its usefulness for early warning during different real and simulated situations. Functional and architectural choices have permitted interoperability with allied nations. However, the information produced was only the first step of the diagnostic epidemiological situation followed by other investigations. This first step of development has highlighted the required complementarity with traditional epidemiological surveillance.
Asunto(s)
Brotes de Enfermedades/prevención & control , Personal Militar , Vigilancia de la Población/métodos , Interpretación Estadística de Datos , Francia/epidemiología , Guyana Francesa , HumanosRESUMEN
BACKGROUND: A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response. METHODS: Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants. RESULTS: It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance. CONCLUSION: Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.
Asunto(s)
Dengue/epidemiología , Brotes de Enfermedades , Personal Militar , Vigilancia de la Población/métodos , Dengue/diagnóstico , Dengue/prevención & control , Brotes de Enfermedades/prevención & control , Diagnóstico Precoz , Guyana Francesa/epidemiología , Humanos , Medicina MilitarRESUMEN
To investigate if the characteristics of human intestinal Escherichia coli are changing with the environment of the host, we studied intestinal E. coli from subjects having recently migrated from a temperate to a tropical area. We determined the phylogenetic group, the prevalence of the antibiotic resistance, the presence of integrons and the strain diversity in faecal isolates from 25 subjects originally from metropolitan France and expatriated to French Guyana. These characteristics were compared with those of 25 previously studied Wayampi Amerindian natives of French Guyana and from 25 metropolitan French residents. The three groups of subjects were matched for age and sex, had not taken antibiotics for at least 1 month, nor had been hospitalized within the past year. In all, the characteristics of intestinal E. coli from Expatriates were intermediate between those found in residents from metropolitan France and those found in natives of French Guyana. Prevalence of carriage of resistant Gram-negative bacteria in Expatriates was intermediate between French residents and Wayampi as were the prevalence of integrons in E. coli (12.3% versus 16.3% and 7.8% respectively), and the intra-host diversity of E. coli (2.3 strains/subject versus 1.9 and 3.1, respectively); lastly, in Expatriates, the prevalence of carriage of phylogenetic group B2 strains was lower than in French residents (16% versus 56%, P = 0.005), while carriage of phylogenetic group A strains was lower than in Wayampi (56% versus 88%, P = 0.03). Our results suggest that the composition of the commensal intestinal flora of humans is not static but changes dynamically in response to new environmental conditions.
Asunto(s)
Portador Sano/microbiología , Escherichia coli/clasificación , Escherichia coli/genética , Tracto Gastrointestinal/microbiología , Farmacorresistencia Bacteriana/genética , Emigración e Inmigración , Escherichia coli/efectos de los fármacos , Femenino , Francia , Guyana Francesa , Humanos , Indígenas Sudamericanos/etnología , Masculino , Pruebas de Sensibilidad Microbiana , Filogenia , ViajeRESUMEN
BACKGROUND: To evaluate a new military syndromic surveillance system (2SE FAG) set up in French Guiana. METHODS: The evaluation was made using the current framework published by the Centers for Disease Control and Prevention, Atlanta, USA. Two groups of system stakeholders, for data input and data analysis, were interviewed using semi-structured questionnaires to assess timeliness, data quality, acceptability, usefulness, stability, portability and flexibility of the system. Validity was assessed by comparing the syndromic system with the routine traditional weekly surveillance system. RESULTS: Qualitative data showed a degree of poor acceptability among people who have to enter data. Timeliness analysis showed excellent case processing time, hindered by delays in case reporting. Analysis of stability indicated a high level of technical problems. System flexibility was found to be high. Quantitative data analysis of validity indicated better agreement between syndromic and traditional surveillance when reporting on dengue fever cases as opposed to other diseases. CONCLUSIONS: The sophisticated technical design of 2SE FAG has resulted in a system which is able to carry out its role as an early warning system. Efforts must be concentrated on increasing its acceptance and use by people who have to enter data and decreasing the occurrence of the frequency of technical problems.
Asunto(s)
Brotes de Enfermedades , Medicina Militar , Personal Militar , Vigilancia de la Población/métodos , Salud Pública , Medicina Tropical , Femenino , Guyana Francesa , Humanos , Masculino , Medicina Militar/métodos , Personal Militar/estadística & datos numéricos , Investigación Cualitativa , Encuestas y Cuestionarios , Síndrome , Factores de Tiempo , Medicina Tropical/métodos , Reino UnidoRESUMEN
An outbreak of malaria occurred among 62 policemen following an operation against illegal gold panning in French Guiana. A retrospective cohort study was conducted. The objectives were to describe the outbreak and to identify factors related to the cases. The total number of initial cases was 37. Both Plasmodium falciparum and Plasmodium vivax were detected. Twenty-seven policemen presented with one to four recurrences. In bivariate analysis, factors related to malaria were a "medium to high" level of mosquito bites pollution at night, late washing in the evening and wearing a nonimpregnated Battle Dress Uniform (BDU). This investigation confirmed the low level of compliance with chemoprophylaxis among individuals on long-term assignment in French Guiana. Compliance with mosquito protection measures was satisfactory except for the use of impregnated BDU. Several recommendations were provided. Therefore, this outbreak reminds us that malaria remains a public health problem in French Guiana.
Asunto(s)
Brotes de Enfermedades , Malaria/etnología , Policia , Adulto , Femenino , Francia/etnología , Guyana Francesa/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Between 1967 and 1987 in the Southern Marquesas, a remote archipelago in French Polynesia, the detection rate of leprosy was 48.9 per 100,000 when it was 8.6 per 100,000 for French Polynesia as a whole. In 1988, a program of chemoprophylaxis of leprosy with a single dose of 25 mg/kg rifampin was implemented, and 2751 persons (98.7% of the population) were treated in the Southern Marquesas. In addition, 678 South Marquesans and 2466 members of their families living in the Northern Marquesas and in the Society Archipelago, received the same chemoprophylaxis. Among 2676 persons studied in the Southern Marquesas (97.4% of the treated population), 130 had elevated IgM anti-phenolic glycolipid-I antibodies by ELISA without any evidence of leprosy. The onset of a skin lesion of borderline leprosy in a boy 3 months after chemoprophylaxis raises the question of the nature of such a skin lesion and, indirectly, of the effectiveness of the chemoprophylaxis