On 6 December 2013, two laboratory-confirmed cases of chikungunya without a travel history were reported on the French part of the Caribbean island of Saint Martin, indicating the start of the first ...documented outbreak of chikungunya in the Americas. Since this report, the virus spread to several Caribbean islands and French Guiana, and between 6 December 2013 and 27 March 2014 more than 17,000 suspected and confirmed cases have been reported. Further spread and establishment of the disease in the Americas is likely, given the high number of people travelling between the affected and non-affected areas and the widespread occurrence of efficient vectors. Also, the likelihood of the introduction of the virus into Europe from the Americas and subsequent transmission should be considered especially in the context of the next mosquito season in Europe. Clinicians should be aware that, besides dengue, chikungunya should be carefully considered among travellers currently returning from the Caribbean region.
Little is known about the Anopheles fauna of Saint-Georges de l'Oyapock, a persistent malaria-endemic municipality in French Guiana. This study aimed to update the knowledge of local Anopheles ...diversity, and their ecology and role in malaria transmission. Sampling sessions were implemented between September 2013 and October 2014. Four species were identified from the 3,450 specimens collected: Anopheles darlingi Root, An. braziliensis, An. triannulatus s.l., and An. nuneztovari s.l. Anopheles darlingi was the predominant species. Its involvement in malaria transmission was suspected due to 1) its abundance, 2) the presence of a density peak during the malaria emergence period, and 3) a dynamic correlated with malaria cases observed two months later. Present and past studies show that the influence of environmental conditions on malaria vector dynamics is high, and may vary drastically according to the local context. This supports evidence that control strategies must be designed at fine scales.
(N Engl J Med 2018;378:985–994)It is well recognized that Zika virus (ZIKV) infection during pregnancy can cause severe birth defects. Fortunately, the presence of centralized maternal care ...facilities in French territories in the Americas (French Guiana, Guadeloupe, and Martinique) allowed for enhanced surveillance of all pregnancies during the 2016 ZIKV epidemic. The authors of the present study present pregnancy outcomes in a cohort of women living in these territories who had symptomatic, laboratory-confirmed ZIKV infection during pregnancy (ZIKA-DFA-FE cohort study).
To identify local meteorological drivers of dengue fever in French Guiana, we applied an original data mining method to the available epidemiological and climatic data. Through this work, we also ...assessed the contribution of the data mining method to the understanding of factors associated with the dissemination of infectious diseases and their spatiotemporal spread.
We applied contextual sequential pattern extraction techniques to epidemiological and meteorological data to identify the most significant climatic factors for dengue fever, and we investigated the relevance of the extracted patterns for the early warning of dengue outbreaks in French Guiana.
The maximum temperature, minimum relative humidity, global brilliance, and cumulative rainfall were identified as determinants of dengue outbreaks, and the precise intervals of their values and variations were quantified according to the epidemiologic context. The strongest significant correlations were observed between dengue incidence and meteorological drivers after a 4-6-week lag.
We demonstrated the use of contextual sequential patterns to better understand the determinants of the spatiotemporal spread of dengue fever in French Guiana. Future work should integrate additional variables and explore the notion of neighborhood for extracting sequential patterns.
Dengue fever remains a major public health issue in French Guiana. The development of new methods to identify such specific characteristics becomes crucial in order to better understand and control spatiotemporal transmission.
Following of the emergence of Zika virus in Brazil in 2015, an epidemiological surveillance system was quickly implemented in the French overseas Territories of America (FTA) according to previous ...experience with dengue and chikungunya and has detected first cases of Zika. General practitioners and medical microbiologists were invited to report all clinically suspected cases of Zika, laboratory investigations were systematically conducted (RT-PCR). On 18 December, the first autochthonous case of Zika virus infection was confirmed by RT-PCR on French Guiana and Martinique, indicating introduction of Zika virus in FTA. The viral circulation of Zika virus was then also confirmed on Guadeloupe and Saint-Martin. We report here early findings on 203 confirmed cases of Zika virus infection identified by RT-PCR or seroneutralisation on Martinique Island between 24 November 2015 and 20 January 2016. All cases were investigated. Common clinical signs were observed (maculopapular rash, arthralgia, fever, myalgia and conjunctival hyperaemia) among these patients, but the rash, the foundation of our case definition, may be absent in a significant proportion of patients (16%). These results are important for the implementation of a suspected case definition, the main tool for epidemiological surveillance, in territories that may be affected by ZIKV emergence, including Europe.
Malaria is endemic in French Guiana. Plasmodium falciparum and Plasmodium vivax are the predominant species responsible and Anopheles darlingi is described as the major vector. In mid-August 2008, an ...increase in malaria incidence was observed in Sauel. A retrospective cohort survey was performed. In vitro susceptibility profiles to antimalarials were determined on P. falciparum isolates. Collections of mosquitoes were organized. The malaria attack rate reached 70.6/100. The risk of malaria increased for people between 40 and 49 years of age, living in a house not subjected to a recent indoor residual insecticide spraying or staying overnight in the surrounding forest. All isolates were susceptible. Anopheles darlingi females and larvae were collected in the village suggesting a local transmission. Our results strongly support a role of illegal mining activities in the emergence of new foci of malaria. Therefore, public health authorities should define policies to fight malaria at a transborder level.
Background: A dengue fever outbreak occurred in the interior of French Guiana from November 2005 onwards. An investigation, with epidemiological, entomological and public health inputs, was ...initiated. Its objectives were to confirm the outbreak, to describe the emergence of dengue fever in the High Maroni area and to initiate a specific public health response. Methods: The investigation was conducted in Maripasoula in February 2006, the biggest community in that part of the country. Definition criteria were used for suspected, probable and confirmed cases of dengue fever. An entomological evaluation for larvae and adult mosquitoes was carried out. Some personal and collective vector control measures were set up by the vector control team. Results: This survey identified 127 suspected dengue fever cases, whereas the epidemiological surveillance system detected only six probable and confirmed cases from the same place and for the same period. The proportion of dengue fever was higher in those people who had not travelled (23.5%) than within the population that had travelled (15.3%) in the three previous months (P = 0.01). Larvae of Stegomyia aegypti were found throughout the town, and adults were captured in 90.9% of the houses. Conclusion: This is the first time that a dengue fever outbreak has been described beyond the coastal region of this French overseas Department.
Malaria, which was eliminated first from Metropolitan France (mainland and Corsica), then in the French West Indies and the Reunion Island during the 20(th) century, remains endemic in two French ...territories: French Guiana and the Indian Ocean Mayotte island. Despite differences in the dominating plasmodial species and epidemiological patterns, these two territories have achieved marked quantitative improvements (in the reported number of cases and severe cases) thanks to efforts undertaken over the past decade. The situation, however, remains a concern from a qualitative standpoint with the emergence of resistance to antimalarial drugs and logistical and administrative issues which hinder access to treatment. Although malaria was eradicated in Metropolitan France half a century ago, competent vectors remain present in part or all of these territories and can give rise to limited outbreaks.
Résumé
Les régions de Guadeloupe, de Guyane et de la Martinique et les collectivités de Saint-Martin et Saint-Barthélemy ont déployé au niveau local un dispositif spécifique pour surveiller ...l’émergence de la grippe A(H1N1) 2009. Après une phase de confinement basée sur la détection et la gestion individuelle des cas, une surveillance a été mise en place à l’échelle populationnelle, essentiellement basée sur les données des réseaux de médecins sentinelles et les confirmations virologiques. Tout comme l’ensemble des pays de la zone caraïbe, les cinq territoires ont subi une épidémie liée au virus A(H1N1) 2009 ayant débuté entre août et septembre 2009. Malgré une dynamique similaire, ces vagues épidémiques ont présenté des spécificités en termes d’ampleur et de sévérité, avec un taux d’attaque variant de 28 à 70 pour 1 000 habitants et un taux d’hospitalisation de 4,3 à 10,3 pour 1 000 cas. Les outils de surveillance mis en place ont permis d’obtenir une vision globale et précise des caractéristiques de l’épidémie et semblent donc tout à fait adéquats pour surveiller une éventuelle nouvelle vague épidémique. Certaines difficultés liées au contexte géographique ou sanitaire spécifique des territoires concernés (complexité de l’acheminement des prélèvements pour la surveillance virologique, survenue concomitante d’épidémies de dengue) sont apparues, et à l’inverse certaines spécificités locales (présence de comités d’experts et de réseaux actifs de médecins sentinelles) ont facilité la surveillance et la gestion de l’épisode.
Guadeloupe, French Guiana, Martinique, St. Martin and St. Barthelemy were the French territories most exposed to the new influenza A(H1N1)v, and adequate epidemiological surveillance tools were ...promptly developed in order to detect its emergence. The first stage, "containment phase", consisted in detection and management of individual cases. Then, when an autochthonous A(H1N1)v circulation was confirmed, its evolution has been monitored within the whole population, mainly through data collected from sentinel doctors' networks and virological surveillance. This allowed to detect very early the occurrence of epidemics, and to follow their evolution until they were over. Like all the other Caribbean countries, the five French overseas territories were hit by an outbreak of influenza A(H1N1)v. Although they had globally similar characteristics, each epidemic had its specificity in terms of scale and severity. They started between August and September 2009 in four of the five territories, while the last one, St. Barthelemy, was not affected until the end of the year. Attack rate estimates varied from 28 to 70 per 1000 inhabitants according to the territory, and hospitalisation rate varied from 4.3 to 10.3 per 1000 cases. Severity rate didn't reach 1 per 1000 cases in any of the territories. Compared to metropolitan France, the surveillance system presented several strengths, including the pre-existence of both an active sentinel network and an expert committee on emerging diseases in each territory. On the other hand, specific difficulties appeared, notably linked with logistical aspects of virological surveillance and the co-circulation of dengue virus in Guadeloupe and St. Barthelemy. Despite these difficulties, the different tools allowed early detection of the epidemics and follow-up of their evolution. All of them lead to very concordant results, suggesting that they are completely appropriate to monitor a potential new epidemic wave.
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