Measles elimination efforts and 2008-2011 outbreak, France.

Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008-2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80% of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met.

[Measles in France]. / La rougeole en France.

From January 2008 to May 2012, over 22,000 cases of measles were reported in France. The highest incidence rate was observed in children below one year of age. Over 50% of cases were reported in young adults. Almost 5,000 patients were hospitalised including 1,023 with severe pneumonia, 27 with encephalitis and/or myelitis : 10 died. This situation is linked to insufficient and heterogeneous vaccination coverage with pockets of susceptible people allowing virus circulation. Although the vaccine coverage in children has now improved for both doses, the issue of convincing young susceptible adults to catch up for measles vaccination remains critical, if the elimination target is to be met, and in order to protect the most vulnerable population unable to benefit from this vaccination (children below 1 year, immunodeficient people, pregnant women).

Progress in the surveillance and control of Legionella infection in France, 1998-2008.

BACKGROUND: In France, the notification of Legionnaires' disease (LD) has been mandatory since 1987. Following a study showing an important under-reporting of the disease, the surveillance system was strengthened in 1997: the urinary antigen detection test was introduced as a new diagnostic tool and guidelines for prevention and control of the disease were implemented. After these measures, the incidence of LD increased gradually, reaching 2.5 per 100,000 in 2005, and then slightly decreased (2.0 per 100,000 in 2008). METHODS: Data from the mandatory notification system and from the national reference centre for Legionella were analysed. Analysis covered the 1998-2008 period. RESULTS: During the period 1998-2008 a total of 11147 cases of LD were reported in France through the mandatory system. The majority of cases were diagnosed by urinary antigen test. The median age of cases was 61 years, the male to female ratio was 2.9, and the case fatality rate was 13%. Exposure during travel was documented for 17% of cases. A hospital-acquired infection was suspected for 9% of cases, and this percentage decreased from 21% in 1998 to 7% in 2008. Over this period, 14 community outbreaks were identified involving 380 cases, and cooling towers were the most probable source of infection for 13. No outbreak was reported in 2008. Registration at the regional level of all cooling towers became mandatory at the end of 2004, and the 1997 prevention and control guidelines were updated in 2005. In recent years, several regulations have also been implemented in the hospital setting and care homes for the elderly. CONCLUSION: All these measures have contributed to strengthen the French surveillance system and improve our ability to better prevent, detect, and control LD.