Assessing the Extent of Covid-19 Transmission in French Guiana

Intro: The emergence of SARS-CoV-2 was accompanied by great uncertainty regarding the main epidemiological characteristics of the transmission. In a context where epidemiological surveillance was mainly targeted on symptomatic patients, we assessed the extent of SARS-CoV-2 transmission in French Guiana conducting an intra-household transmission study and population-based seroprevalence surveys repeated over time. Method(s): Household monitoring included virological and clinical follow-up for all household members for the first 28 days after the date of confirmation of the index case and serological follow-up over a 12-month period. Three seroprevalence surveys were conducted in July and September 2020 and in September 2021. Finding(s): A total of 57 dwellings including 245 individuals were included in the intra-household study. The average time between the date of onset of symptoms and the date of confirmation of diagnosis and inclusion in the study was 4.2 days and 7.2 days respectively. Secondary transmission was found in three quarters of households with a secondary infection rate of 35%. The highest transmission rate were observed in the most disadvantaged populations, within couples and from adults to children. Population-based seroprevalence studies have made it possible to monitor seroprevalence rates, which have varied from 15% at the time of the epidemic peak of the first epidemic wave to 65% of the population at the beginning of the fourth wave, despite the low impact of vaccination in French Guiana. Conclusion(s): The results obtained highlighted a high transmission of the virus in French Guiana associated with a low severity rate linked to the structure of the particularly young population. The project has provided health authorities with useful data to support prevention and control strategies and has allowed to evaluate the impact of interventions implemented during the pandemic.Copyright © 2023

Verification of two alternative do-it-yourself equipment respirator seal as COVID-19 protection (VADERS-CoV) : a quality assessment pilot study

Background : During the COVID-19 pandemic, healthcare workers were facing shortage in personal protective equipment, especially adequate respirators. Alternative do-it-yourself respirators emerged, without any proof of protection. Objective : Verify seal potential of two alternative respirators compared to a common FFP2 respirator. Design : Quality assessment pilot study. Setting : Tertiary Care Hospital. Participants : Ten anaesthesiology residents. Interventions : Participants performed quantitative face-fit tests (QNFT) with three respirators to evaluate seal. A common FFP2 "duckbill" respirator was used as baseline (control group). Alternatives tested in this study were an anaesthesia face mask and a full-face modified snorkelling mask with a 3D-printed connector, both in conjunction with a breathing system filter. Main outcome : Non-inferior seal performance of the alternatives over FFP2, assessed by calculated QNFT based on measured individual fit factors, as defined by the Occupational Safety and Health Administration. Results :For each respirator a total of 90 individual fit factor measurements were taken. Within the control group, seal failed in 37 (41%) measurements but only in 10 (11%) within the anaesthesia mask group and in 6 (7%) within the snorkelling mask group (P < 0.001 respectively). However, when calculating the final, mean QNFT results, no difference was found between respirators. Successful QNFT were determined for 5 out of 10 participants in the FFP2 group, for 8 in the anaesthesia mask group (P = 0.25) and for 7 in the snorkelling mask group (P = 0.69). Conclusion : Both do-it-yourself respirators successfult) pass QNFT and have the potential to provide non inferior seal compared to a common FFP2 respirator. While anaesthesia masks are easily assembled, snorkelling masks must undergo significant but feasible modifications. Our results suggest that those do-it-yourself respirators seem to be viable alternatives for situations when certified respirators are not available but need further investigation for validation. Trial registration: Clinicaltrials. gov identifier: NCT04375774 Key Points : Question: Can alternative do-it-yourself respirators protect wearers from hazardous aerosols? Findings : Our findings demonstrate that do-it-yourself respirators have the potential to provide non-inferior seal as compared to regular FFP2 personal protective equipment. Meaning : Our real-life situational testing provides evidence that do-it-yourself respirators potentially provide sufficient seal to compete with or even outperform conventional FFP2 respirators and that face-fit testing should be a mandatory safety check in healthcare providers.

Attitudes towards the COVID-19 vaccine and vaccination willingness among healthcare workers in French Guiana

Background - In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (P1) variant of concern (VOC), mRNA vaccines were made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimes to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. Methods - A cross-sectional survey was conducted from January 22 to March 26, 2021, among a sample of HCWs in French Guiana based on an anonymous online questionnaire. Results - A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing to be or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. In multivariate analysis, factors associated with vaccination willingness were older age, level of concern about COVID-19, confidence in vaccine information, and having been vaccinated against influenza in the previous year. Conversely, reluctance to certain vaccinations in general (adjusted OR=0.23, CI95%: [0.13-0.41]) and being from the West Indies or French Guiana (aOR=0.39 [0.21-0.73]) were associated with greater vaccine distrust. Conclusion - Negative opinions and attitudes toward vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with P1 VOC. Territorial specificities, general vaccine hesitancy and concerns about future side effects in particular represent important barriers and/or issues. Low confidence in government and science are important for COVID-19 vaccine refusal among non-medical staff. Public health messages with information on vaccine safety should be tailored to address these concerns.

Création d'une équipe de coordination dédiée à la vaccination Covid-19 dans les communes isolées de Guyane

Déclaration de liens d’intérêts: Les auteurs déclarent ne pas avoir de liens d’intérêts.

Difficultés et enjeux de la vaccination contre le COVID-19 dans une Guyane multiethnique et multiculturelle

Introduction Depuis la vague épidémique COVID-19 de juin 2020, la Guyane est restée relativement épargnée jusqu’en mars 2021. Du fait de sa proximité avec le géant brésilien, une reprise épidémique avec le variant 20J/501Y.V3 est à craindre. L’effort majeur accordé à l’obtention d’une couverture vaccinale suffisante, qui permettrait de réduire l’impact d’une 3e vague est contraint par des freins culturels et ethniques importants et très différents d’une commune à l’autre vis-à-vis de la vaccination. Matériels et méthodes La mise en place de la vaccination a nécessité l’élaboration de procédures spécifiques à chaque commune en fonction notamment des groupes culturels. Une description des constats et modalités d’intervention originales dans les communes isolées de ce territoire est réalisée. Résultats À Saint-Georges de l’Oyapock, ville frontalière avec le Brésil, la population est composée principalement de Créoles, d’Amérindiens Palikur et de Brésiliens vivant de part et d’autres du fleuve Oyapock. La localisation stratégique de cette commune a nécessité de mettre en place une action initiale de sensibilisation puis une stratégie de vaccination massive ponctuelle suivie de la mise en place d’un vaccinodrome. À Camopi et Trois Sauts, sur le Haut Oyapock, la population amérindienne Wayãpi et Teko a une adhésion lente et progressive à la vaccination, et quelques doses sont injectées de façon hebdomadaire. À Cacao, situé à 1h30 de route de Cayenne, la population Hmong originaires du Laos, présente une acceptabilité élevée du vaccin qui a été renforcée après une réunion avec les chefs des familles du village. Sur le Haut Maroni, en pays Amérindien Wayana, une rencontre avec les chefs coutumiers, plutôt réticents, a eu lieu. La vague épidémique de juillet 2020 aurait touché une part importante de la population avec une morbimortalité ressentie très modérée incitant les chefs à temporiser la décision d’encourager leurs populations à se faire vacciner. Enfin, chez les bushinenges du Maroni, descendants des esclaves africains du Suriname, les opinions anti-vaccin sont majoritaires. Les fausses rumeurs et théories complotistes circulent largement au sein de cette population transfrontalière limitant le lancement de la vaccination. Conclusion La progression de la couverture vaccinale est freinée par le vaccinosepticisme d’une partie importante de la population de Guyane ayant entraîné fin mars un élargissement des indications a tous les personnes de plus de 30 ans vivant sur le territoire guyanais avec uniquement le vaccin Pfizer, l’AztraZeneca ayant été récusé du fait du risque d’échec face au variant V3. Ce scepticisme contraste avec l’avidité à se faire vacciner de la population brésilienne vivant en Guyane et de l’autre côté des frontières, lié à la situation sanitaire préoccupante et les difficultés d’accès au vaccin dans leur pays. Le travail de sensibilisation se poursuit adapté à chaque communauté. La course contre la montre est engagée, face à l’arrivée imminente d’une 3e vague en lien avec le variant amazonien mais également avec ceux importés de métropole.