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.
Historical epidemics that occurred in 2010 in America were preceded by warning signs that could be detectable by epidemiological and biological surveillance.
•In 2010, historical epidemics occurred ...in the French West Indies.•Extreme temperature during the dry season could have improved virus circulation.•Warning signs can be early detected by epidemiological and biological surveillance.•Integrated management strategies are needed for dengue prevention and control.
Dengue fever has been endemo-epidemic in the whole Region of America. In 2010, Guadeloupe and Martinique experienced historical epidemics, with an estimated attack rate of 10% in two islands. When considering the temporal evolution of epidemiological indicators, an unusual increase in the number of dengue cases could be detected very early. Two main factors might have facilitated the settlement of a viral transmission despite the dry season: a low immunity of the population against the circulating serotype and particular climatic conditions, notably very high temperatures which could have improved both virus and vector efficiency. This unusual situation was considered as a warning sign, and indeed led to major outbreaks in both islands a few weeks later. This event underlines that follow-up of epidemiological indicators is necessary to detect the unusual situations as soon as possible. Furthermore, development of biological and modelling tools should be promoted, as well as integrated management strategies for dengue prevention and control.
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.
Chlordecone is an organochlorine insecticide used until 1993 in the banana plantations of the French Antilles. Recent surveys revealed its wide presence in the environment. This current paper focuses ...on the impact of different management options on the Martinican population’s food exposure, taking into account that an appreciable part of the food consumed in Martinique corresponds to subsistence production. Food exposure is assessed through deterministic models. Consumption data derive from the ESCAL Survey on 1814 subjects aged 3 and over. Residues data come from the Monitoring Programs 2002–2004. Different scenarios are studied depending on whether the subjects live on a soil-contaminated place or not and on their supply habits. The impact of various maximum limits is then analysed. The probability of exceeding the chronic health-based guidance value (CHGV) of 0.5
μg/kg
bw/day is, respectively, 20.9% (CI
95th 6.2; 34.4) and 15.6% (CI
95th 9.6; 20.8) for children and adults living in a soil-contaminated area and null for the remaining population. MLs below 300
μg/kg
fw would reduce significantly the exposure but the probability of exceeding the CHGV remains statistically different from zero when only commercialised products are taken into account. This study shows the supply habits may have significant impacts on food exposure to contaminants. It reveals that setting MLs, which can only be controlled on commercialised products, is not enough in such situations. Other management options like consumption recommendations for self-produced foodstuffs are necessary to protect the Martinican consumer.
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.
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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