Community outbreak of serogroup B invasive meningococcal disease in Beaujolais, France, February to June 2016: from alert to targeted vaccination.

In February and March 2016, four cases of serogroup B invasive meningococcal disease (IMD) occurred over 3 weeks in a small area north of Lyon in the Auvergne-Rhône-Alpes region, France. There were no deaths but two cases had sequelae. This community outbreak was caused by a rare meningococcal strain of the clonal complex ST-32, covered by the 4CMenB/Bexsero vaccine. The incidence rate for serogroup B IMD in this area was 22.5 per 100,000 inhabitants, which is above the epidemic threshold (10/100,000). The number of cases observed was significantly higher than expected in the age group of 0-24 year-olds (standardised incidence ratio: 96). These results suggested the potential emergence of this invasive strain in this sub-population. In accordance with French recommendations, it was decided to vaccinate the population aged between 2 months and 24 years, living, working or studying in the epidemic area. The vaccination campaign took place from April to September 2016. Vaccination coverage was estimated at 47% for one dose and 40% for two doses. The lowest coverage estimations were observed for the age groups younger than 3 and 15-19 years. Enhanced epidemiological and microbiological surveillance reported a fifth case in June 2016, outside the epidemic area.

Capture-recapture method for estimating annual incidence of imported dengue, France, 2007-2010.

Imported dengue cases pose the public health risk for local circulation in European areas, especially southeast France, where the Aedes mosquito is established. Using a capture-recapture method with Chao's estimator, we estimated the annual incidence of dengue fever and the completeness of existing mandatory notification and laboratory network surveillance systems. During 2007-2010, >8,300 cases with laboratory evidence of recent dengue infection were diagnosed. Of these cases, 4,500 occurred in 2010, coinciding with intense epidemics in the French West Indies. Over this 4-year period, 327 cases occurred in southeast France during the vector activity period. Of these, 234 cases occurred in 2010, most of them potentially viremic. Completeness of the mandatory notification and laboratory network systems were ≈10% and 40%, respectively, but higher in southeast areas during May-November (32% and 69%, respectively). Dengue surveillance systems in France provide complementary information that is essential to the implementation of control measures.

Increase in dengue fever imported from Côte d’Ivoire and West Africa to France.

Dengue is usually not considered a significant health problem in Africa because severe forms of dengue illness are rarely reported. In the absence of local surveillance data, the investigation of dengue cases imported to France contributed to document the circulation of dengue virus in this area. From 1 July 2006 to 31 December 2008, a total of 148 dengue cases imported to metropolitan France were reported through the mandatory notification system. Arthralgia and signs of severity (haemorrhage, thrombocytopenia) were less frequent in patients returning from West African countries. DENV-3 was isolated in two patients from Côte d’Ivoire in 2008. The number and proportion of patients returning from Côte d’Ivoire to France increased significantly in 2008 compared with the previous 18-month period. In parallel, the marginal increase in air travel does not explain the high increase observed in imported dengue cases to France. Our data illustrate increased dengue circulation and the emergence of DENV-3 in this area, with public health implications for epidemiological surveillance and case management locally.

Atypical aetiology of a conjugal fever: autochthonous airport malaria between Paris and French Riviera: a case report.

Endemic malaria has been eradicated from France, but some falciparum malaria cases have been described in patients who have never travelled outside the country. Ms. V. 21 year-old and Mr. M. 23 year-old living together in Paris were on holiday in Saint Raphaël (French Riviera). They presented with fever, vertigo and nausea. A blood smear made to control thrombocytopaenia revealed intra-erythrocytic forms of Plasmodium falciparum. The parasitaemia level was 0.15% for Ms. V and 3.2% for Mr. M. This couple had no history of blood transfusion or intravenous drug use. They had never travelled outside metropolitan France, but had recently travelled around France: to Saint Mard (close to Paris Charles de Gaulle (CdG) airport), to Barneville plage (in Normandy) and finally to Saint Raphaël. The most probable hypothesis is an infection transmitted in Saint Mard by an imported anopheline mosquito at CdG airport. The DNA analysis of parasites from Ms. V.'s and Mr. M.'s blood revealed identical genotypes. Because it is unlikely that two different anopheline mosquitoes would be infected by exactly the same clones, the two infections must have been caused by the infective bites of the same infected mosquito.