Timely detection of bronchiolitis epidemics in Guadeloupe / Detección oportuna de epidemias de bronquiolitis en Guadalupe

Objective. To develop a criterion for early detection of bronchiolitis epidemics in Guadeloupe so that prevention and control strategies can be implemented in a more timely manner. Methods. Weekly figures of bronchiolitis cases reported from July 2005­July 2010 by Guadeloupe's sentinel network were used. The criterion for detecting epidemics was created with data from the 2005­2009 bronchiolitis seasons. First, the baseline level for bronchiolitis (BL) was predicted by fitting a periodic regression on the non-epidemic observations; then a test was conducted of nine possible criteria to define epidemics by combining a statistical threshold set at different levels and a number of consecutive weeks with observations above and below them; lastly, the optimal criterion was selected considering its performances using expert advice as the gold standard. The selected criterion was validated with data from 2009­2010 season. Results. The BL accounted for a linear trend and two sinusoidal functions of 52 and 26 weeks (R2 = 45%). According to the epidemic criterion selected, the statistical threshold was set at the upper limit of the one-sided 95% Confidence Interval of the predicted BL; 2 consecutive weeks with cases above it were necessary to set the start of an epidemic, and three again below to set the end. The median delay in launching the alerts was 2 weeks; there was one false alert; and the sensitivity, specificity, and positive predictive value for detecting epidemic weeks were 98%, 96%, 95%, respectively. During the validation period, the criterion launched one false alert and detected the epidemic with 4 weeks of delay. Conclusions. This criterion supports epidemiologists in timely interpretation of bronchiolitis epidemiological data for decision makers in Guadeloupe. In the future, it should be updated in accordance with trends in bronchiolitis epidemiology, and improved by integrating virological indicators. Its inclusion in an integrated management strategy for bronchiolitis prevention and control, supported by a bronchiolitis public health network, should also be encouraged.

Objetivo. Formular un criterio para la detección temprana de las epidemias de bronquiolitis en Guadalupe, a fin de aplicar de manera más oportuna mejores estrategias de prevención y control. Métodos. Se usaron las cifras semanales de los casos de bronquiolitis notificados desde julio del 2005 hasta julio del 2010 por la red de vigilancia de Guadalupe. El criterio para detectar las epidemias se estableció con los datos de las temporadas de bronquiolitis del 2005 al 2009. En primer lugar, se predijo el nivel basal de bronquiolitis ajustando una regresión periódica a los casos observados fuera de las epidemias; luego se pusieron a prueba nueve posibles criterios para definir las epidemias combinando un umbral estadístico establecido a diferentes niveles y un número de semanas consecutivas con las observaciones ubicadas por encima y por debajo de ellos; por último, se seleccionó el criterio óptimo conforme a su desempeño, usando el asesoramiento de expertos como criterio de referencia. El criterio seleccionado se validó con los datos de la temporada 2009­2010. Resultados. El nivel basal de bronquiolitis presentaba una tendencia lineal y dos funciones sinusoidales de 52 y 26 semanas (R2 = 45%). Según el criterio de epidemia seleccionado, se fijó el umbral estadístico en el límite superior del intervalo de confianza de 95% unilateral del nivel basal de bronquiolitis previsto; para establecer el comienzo de una epidemia se requerían 2 semanas consecutivas con casos por encima de él, y 3 semanas con casos por debajo para determinar su finalización. La mediana del retraso para lanzar las alertas fue 2 semanas; hubo una alerta falsa; y la sensibilidad, la especificidad y el valor predictivo positivo para detectar las semanas de epidemia fueron 98%, 96% y 95%, respectivamente. Durante el período de validación se emitió, según el criterio, una alerta falsa y se detectó la epidemia con 4 semanas de retraso. Conclusiones. Este criterio ayuda a los epidemiólogos a interpretar de manera oportuna los datos epidemiológicos de bronquiolitis a fin de tomar decisiones en Guadalupe. En el futuro, debe actualizarse según las tendencias en la epidemiología de la bronquiolitis, y mejorarse mediante su integración con indicadores virológicos. También debe promoverse su inclusión en una estrategia integrada de manejo para la prevención y el control de la bronquiolitis, apoyada por una red de salud pública relacionada con la bronquiolitis

Hospitalized cases of influenza A(H1N1)pdm09 in the French territories of the Americas, July 2009–March 2010 / Casos hospitalizados de gripe A(H1N1)pdm09 en los territorios franceses de las Américas entre julio de 2009 y marzo de 2010

Objective. To describe the methodology used for implementing a surveillance system specifically for influenza A(H1N1)pdm09 in the French West Indies and French Guiana during an outbreak of this new virus in 2009­2010, and to report its main results. Methods. This was an observational descriptive study of confirmed and probable cases of influenza A(H1N1)pdm09 hospitalized for at least 24 hours in 23 July 2009­3 March 2010. Reverse transcription polymerase chain reaction was performed on nasopharyngeal swab samples according to the Centers for Disease Control and Prevention protocol. A probable case was defined as fever ≥ 38°C or aches or asthenia with respiratory symptoms (cough or dyspnea). All confirmed and probable hospitalized cases were reported, along with patient's age, sex, clinical condition at admission, place and length of hospitalization, antiviral treatment, underlying conditions, complications, and clinical evolution. A case was classified as severe if respiratory assistance or intensive care was required or if death resulted. Results. A total of 331 confirmed and 16 probable cases were hospitalized, with a hospitalization rate ranging from 4.3 per 1 000 clinical cases in Saint Martin to 10.3 in French Guiana. Of these, 36 were severe, and subsequently, 10 were fatal. The median length of stay was 4 days for non-severe cases and 9 days for severe (P < 0.05). The mean patient age was 21 years, and severe cases were significantly older than non-severe (mean: 38 years versus 19 years, P < 0.05). Underlying conditions associated with a higher risk of severity were 65 years of age or more (RR = 7.5, 95%CI = 4.2­13.3), diabetes (RR = 3.7, 95%CI = 1.5­9.4), cardiac insufficiency (RR = 8.4, 95%CI = 5.2­13.6), and morbid obesity (RR = 4.4, 95%CI = 1.8­ 10.4). Patients who received antiviral treatment within 2 days of symptom onset had shorter hospital stays (mean: 4 days versus 6.5 days, P < 0.05), and the illness tended to become less severe (11.1% versus 19.0%, P = 0.13). Conclusions. Active research of hospitalized cases enabled almost exhaustive surveillance. The pandemic's hospitalization rates and lethality were more moderate than expected. Some previously known underlying conditions of severity were confirmed dur.

Objetivo. Describir la metodología usada para implementar un sistema de vigilancia específico para la gripe A(H1N1)pdm09 en las Indias Occidentales Francesas y la Guayana Francesa durante un brote ocasionado por este virus nuevo ocurrido en 20092010 y presentar sus principales resultados. Métodos. Se llevó a cabo un estudio de observación descriptivo de los casos confirmados y probables de gripe por A(H1N1)pdm09 hospitalizados durante al menos 24 horas entre el 23 de julio de 2009 y el 3 de marzo de 2010. De conformidad con el protocolo de los Centros para el Control y la Prevención de Enfermedades se realizó la prueba de reacción en cadena de la polimerasa con transcripción inversa en muestras de hisopados nasofaríngeos. Se definió como caso probable la presencia de fiebre ≥ 38 °C o dolores o astenia junto con síntomas respiratorios (tos o disnea). Se comunicaron todos los casos hospitalizados confirmados y probables junto con la edad, el sexo, la situación clínica del paciente en el momento del ingreso, el lugar y la duración de la hospitalización, el tratamiento antivírico, las enfermedades subyacentes, las complicaciones y la evolución clínica. Se clasificaron como graves los casos que requirieron asistencia respiratoria o cuidados intensivos o provocaron la muerte. Resultados. Fueron hospitalizados en total 331 casos confirmados y 16 probables, con una tasa de hospitalización que osciló entre 4,3 por cada 1 000 casos clínicos en San Martín y 10,3 por cada 1 000 en la Guayana Francesa. De ellos, 36 fueron graves y 10 llevaron posteriormente a la muerte del paciente. La mediana de la duración de las hospitalizaciones fue de 4 días para los casos no graves y de 9 días para los graves (P < 0,05). La edad media de los pacientes fue de 21 años, y los casos graves fueron significativamente de mayor edad que los no graves (media: 38 años frente a 19 años; P < 0,05). Las enfermedades subyacentes asociadas con un riesgo mayor de gravedad fueron edad de 65 años o más (RR = 7,5; IC de 95% = 4,213,3), diabetes (RR = 3,7; IC de 95% = 1,59,4), insuficiencia cardíaca (RR = 8,4; IC de 95% = 5,213,6) y obesidad mórbida (RR = 4,4; IC de 95% = 1,810,4). En los pacientes que recibieron tratamiento antivírico en el plazo de 2 días de la aparición de los síntomas las estancias hospitalarias fueron más breves (media: 4 días frente a 6,5 días; P < 0,05) y la enfermedad tendió a presentar menor gravedad (11,1% frente a 19,0%; P = 0,13). Conclusiones. La investigación activa de los casos hospitalizados permitió una vigilancia casi exhaustiva. Las tasas de hospitalización y la letalidad de la pandemia fueron más moderadas que lo previsto. Durante este brote se confirmó la capacidad de algunas enfermedades subyacentes ya conocidas para aumentar la gravedad. Además, estos resultados demuestran la validez del tratamiento antivírico temprano

Which anaesthesia should be recommended for prostate biopsy / ¿Qué Anestesia debe Recomendarse para la Biopsia de la Próstata?

OBJECTIVE: Although transrectal ultrasound-guided prostatic biopsies are associated with significant discomfort and pain, most urologists do not use any kind of anaesthesia. We therefore compared the efficacy of two local anaesthetics, namely, the rectal administration of lidocaine gel and lidocaine periprostatic infiltration prior to biopsies. DESIGN AND METHODS: Three hundred and fifty-six randomized patients received either 15 mL of 2 lidocaine gel administered intrarectally ten minutes before prostate biopsies in group 1 (180 patients) or 10 mL of 1 lidocaine given under ultrasound guidance in two periprostatic injections of 5 mL, four minutes before the biopsies in group 2 (176 patients). A visual analogue scale (VAS) was used to assess the pain score during anaesthesia (VAS 1), during the biopsies (VAS 2) and 30 minutes after them (VAS 3). RESULTS: Patients receiving lidocaine gel experienced statistically less pain than the lidocaine injection group for mean VAS 1 (0.1 vs 1.4, p < 0.0001) and mean VAS 3 (0.8 vs 1.4, p < 0. 001) but VAS 2 showed no statistically significant difference (2.0 vs 2.1). No major morbidity was noted with either anaesthetic. CONCLUSION: Rectal administration of lidocaine gel is both safe, simple and effective and results are more satisfactory than with lidocaine periprostatic infiltration

Objetivo: Aunque las biopsias prostáticas transrectales guiadas mediante ultrasonido se asocian con considerable malestar y dolor, la mayoría de los urólogos no usa cualquier tipo de anestesia. Por lo tanto, comparamos la eficacia de dos anestésicos locales, a saber, la administración rectal de gel de lidocaína y la infiltración con lidocaína del área periprostática antes de las biopsias. Diseño y métodos: Trescientos cincuenta y seis pacientes randomizados recibieron o bien 15 mL de lidocaína en gel al 2%, administrada intrarectalmente diez minutos antes de las biopsias de la próstata en el grupo 1 (180 pacientes); o alternativamente 10 mL de lidocaína al 1% administrada bajo la guía de ultrasonido en dos inyecciones periprostáticas de 5 mL, cuatro minutos antes de las biopsias en el grupo 2 (176 pacientes). Se usó una escala analógica visual (EAV) para evaluar el grado de dolor durante la anestesia (EAV 1), durante las biopsias (EAV 2) y 30 minutos después de realizarlas (EAV 3). Resultados: Los pacientes que recibieron lidocaína en gel, experimentaron menos dolor estadísticamente, que el grupo de la inyección de lidocaína, para la VAS 1 media (0.1 frente a 1.4, p <0.0001) y VAS 3 media (0.8 frente a 1.4, p <0.001). Sin embargo, la VAS 2 no mostró diferencia significativa alguna en términos estadísticos (2.0 frente a 2.1). No se vio morbosidad de consideración con ninguno de los anestésicos. Conclusión: La administración rectal de gel de lidocaína es tan segura y simple como efectiva, y siendo los resultados más satisfactorio que aquellos producidos con la infiltración periprostática de lidocaína..

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001 / Revisión retrospectiva de la leptospirosis en Guadalupe, Indias Occidentales Francesas 1994­2001

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases

Se obtuvieron los datos demográficos, clínicos, biológicos y personales de pacientes hospitalizados con síntomas de leptospirosis en el Hospital de Pointe à Pitre, Guadalupe, Indias Orientales Francesas, en el período comprendido de 1994 a 2001. De los 897 pacientes investigados, 212 eran casos graves, 607 eran no infectados y 78 eran casos indeterminados. No hubo grupo etario predominante. La transmisión de la leptospirosis seguía el ciclo hidrológico y era mayor en las áreas rurales. La ictericia y sufusión conjuntival fueron significativamente más frecuentes en los casos que en los no casos. Los varones, las profesiones consideradas en riesgo, y el contacto con cerdos o bovinos estuvieron asociados con la infección. Los serogrupos Icterohemorragia, Cynopteri, Australis, Sejroe, Pomona y Ballum fueron serovares presumiblemente responsables de los casos graves

Epidemiologic study of the association between human T-cell lymphotropic virus type 1 and Strongyloides stercoralis infection in female blood donors (Guadeloupe, French West Indies)

This case control study was conducted among female blood donors in Guadeloupe. A total of 85 HTLV-1 positive subjects were matched by age (+/- 5 years) in a 1:3 ratio to 255 HTLV-1 negative controls. The mean age was 48.5 and 48.9 years respectively. Ethnic, environmental and socio-economic risk factors were studied. Four risk factors were found independently associated with HTLV-1 seropositivity: Strongyloides stercoralis antibodies (OR = 3.6, CI 1.8, 7.3), low socio-economic status (OR = 2.0 CI 1.0, 4.0), low educational level (OR = 2.0 CI 1.0, 4.0) and agricultural activity (OR = 2.8 CI 1.4, 5.6). This logistic regression analysis demonstrates the reality of the association between HTLV-1 carriers and Strongyloides stercoralis, and its association with socio-economic and environmental risk factors

Malaria in Guadeloupe (French West Indies) 1991-2000

The only islands in the Caribbean that still have endemic malaria are Haiti and the Dominican Republic. Cases of imported malaria occur on the other islands, particularly Martinique and Guadeloupe, due to the movement of people to and from endemic regions that are geographically and/or culturally close. The re-emergence of transmission cannot be ruled out due to the local persistence of the potential vectors, the anopheles mosquitoes. This retrospective study, over a ten year-period (1991-2000), included all of the cases of malaria confirmed by blood tests at Pointe-à-Pitre University Hospital. This hospital is the main healthcare facility in Guadeloupe. Fifty-nine bouts of malaria occurred in 56 patients. The annual incidence was estimated at 2 to 2.5 cases per 100,000 inhabitants. Plasmodium falciparum largely predominated, accounting for over 80 of cases. The only pernicious case observed resulted in the death of the patient. In all cases the patient had recently travelled to an endemic region, except in one case, caused by P ovale which has never been endemic in the Caribbean. African countries accounted for 43 of cases. No Asian or Pacific strains were identified. In all cases, anti-malarial drugs were not taken, taken incorrectly or were inappropriate. All of the cases of malaria reported in Guadeloupe in the last decade were imported and this region cannot be considered to be at risk of malaria infection. However, long-term epidemiological monitoring is necessary, together with specific entomological monitoring

Trends of AIDS in Guadeloupe (French West Indies): a longitudinal survey from 1998 to 1997

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.