[Efficacy of radical treatment with halofantrine on the prevention of imported Plasmodium falciparum malaria]. / Efficacité de la cure radicale par halofantrine sur la prévention du paludisme d'importation à Plasmodium falciparum.

We carried out in 1989 a non randomized comparative study in French army units which had been in Central Africa (Central African Republic and Gabon) for 4 months, in order to compare in 758 men on return from malaria areas the usual strategy of chemoprophylaxis with chloroquine and a radical cure by halofantrine (Halfan). Chloroquine was taken by 278 men (100 mg daily for 6 weeks after their return to France); the other 480 men were given two doses of 1,500 mg halofantrine on the third and on the tenth day after their return to France. In Africa both of the units were on chloroquine prophylaxis (100 mg daily for 4 months). The Plasmodium falciparum attack rates were, during a period of 5 months after the return to France, 0.2% in the halofantrine group (1/480) and 4.7% (13/228) in the chloroquine group (P < 10(-4)). The radical cure by halofantrine was more effective than chloroquine prophylaxis in preventing falciparum malaria on return from malaria areas.

[Comparative study of 3 bacteriological tests of cerebrospinal meningitis during the epidemiological period]. / Etude comparative de trois examens bactériologiques de la méningite cérébrospinale en période épidémique.

During an outbreak of group A meningococcal meningitis in Chad in 1988, a comparative study of three bacteriological techniques (direct microscopic examination, latex agglutination, and culture) was conducted with 120 samples of cerebrospinal fluid (CSF) for diagnosis. The results correlated well with cloudy or purulent CSF specimens. Direct microscopic examination was as good a diagnostic indicator as the other tests. The authors recommend using direct microscopic examination, which is easy to perform under field conditions and accurate enough for a rapid diagnosis of cerebrospinal meningitis during an epidemic. However, complete identification of the first cases in the epidemic is important in order to establish control measures as soon as possible.

[Epidemiological notes: meningococcal meningitis of serogroup X in Niamey (Niger)]. / Notes épidémiologiques: les méningites à méningocoques de sérogroupe X à Niamey (Niger).

From 19th February to 15th April 1990, 22 strains of meningococcus belonging to serogroup X have been identified by the Centre for Study and Research on meningitidis and Schistosomiases (CERMES) at Niamey (Niger). Serogroup X has been confirmed by the Centre Collaborating WHO of Reference and Training for Meningococci (CCOMSRFM) at Marseille (France). These strains have been isolated from cerebrospinal fluid of patients suffering from cerebrospinal meningitis and living in different neighbourhoods of Niamey. Apparition of cases of meningococcal meningitis with other serogroups than A implies identification of serogroup of meningococcus in intertropical Africa.

[A new antimalarial on the market: halofantrine. Various observations]. / Un nouvel antimalarique sur le marché: l'halofantrine. Quelques notes.

To face the geographical extension of chloroquine resistant strains of Plasmodium falciparum and the extant of multiple drug resistant strains (with sometimes a loss of quinine sensitivity), a new antimalarial drug which comes on to the market is wellcome. Halofantrine, a phenanthren methanol, licensed as Halfan has been authorized for sell in France in 1988 and is also available in four countries of Tropical Africa: Ivory Coast, Togo, Congo and Zaïre. The current prescription of Halfan is the treatment of acute attacks of P. falciparum in areas where chloroquine resistant strains occur. Halfan is only available under oral form (tablets and drinkable solution). Its clinical and biological tolerability is good.

[Reliability of clinical studies in the diagnosis of malaria fever in West African endemic areas]. / Fiabilité de l'examen clinique dans le diagnostic des fièvres palustres en zone d'endémie ouest-africaine.

We have studied 930 febrile cases in a savanna area of Burkina Faso. We have diagnosed malarial fevers according to the only clinical data in 333 cases and it was confirmed in 154 cases by parasitological study; for 597 cases a non malaria reason was given according to the only clinical data and it was confirmed in 507 cases by biological studies. On the whole the error rate was of 28% on the clinical examination alone and this proportion was equal or superior whatever the parasitological threshold was. The clinical examination is not allow by it self to diagnose a malaria fever case.

[Manpower in Madagascar and training: evaluation of vaccination coverage by cluster sampling in a rural Malagasy environment]. / Bioforce à Madagascar et formation: evaluation de la couverture vaccinale par sondage en grappe en milieu rural malgache.

To assess the immunization coverage, a cluster sampling survey in Malagasy rural areas has been carried out at the occasion of an in-service training in Expanded Programme on Immunization (E.P.I.) organized for 15 Health Medical Inspectors. Leading results are: 17% of children have received B.C.G. immunization. 15% have received D.T.C. 4% have received oral poliomyelitis immunization.

[Training in epidemiology at the Institute of Tropical Medicine of the Army Health Service. Experience over 4 years]. / La formation en épidémiologie à l'Institut de Médecine Tropicale du Service de Santé des Armées. Une expérience de 4 ans.

The authors described the training in epidemiology received by 185 Army medical doctors attached for instruction to the I.M.T.S.S.A. since 1981. Statistical methodology, basic epidemiology, and applied epidemiology are taught in such way that Army medical doctors are better capable of rationalizing and strengthening their action of prevention in their posting either in France or seconded to developing countries. Description of pedagogical targets is underlined as well as methodology of control and evaluation of progress towards these targets. The authors are also able to appreciate, in terms of the level of capacity of the personnel trained, the severity of the consequences either of a strengthening of the pedagogical targets or of a reduction. When the reform of medical education and training imposes very often such an alternative, the authors point out how the leading opinion of the ones who utilize the services of the personnel should be taken into full consideration prior to any decision.

The in-vitro activity of pristinamycin against Haemophilus influenzae and Neisseria meningitidis.

The in-vitro activity of erythromycin, oleandomycin, spiramycin, josamycin and pristinamycin was tested by a plate-dilution method against strains of Haemophilus influenzae and Neisseria meningitidis. Pristinamycin was the most active product tested with minimal inhibitory concentrations (MIC) ranging between 0.5 and 4 mg/l for H. influenzae (modal value 1 mg/l) and between 0.03 and 0.12 mg/l for N. meningitidis (modal value 0.06 mg/l).

[New epidemiologic data on meningococcal meningitis in tropical Africa]. / Quelques données épidémiologiques récentes concernant la méningite ä méningocoque en Afrique tropicale.

From recent data, the authors touch up the epidemiological features of meningococcal meningitis in tropical Africa, especially in Sudano -sahelian areas of countries included in the "Meningitis Belt".

[Mass chemoprophylaxis of malaria, its objectives, its limits, its difficulties]. / La chimioprophylaxie collective du paludisme ses objectifs, ses limites, ses difficultés.

In intertropical Africa, insecticide spreadings cannot succeed by themselves in controlling malarial endemia. They cannot provide any eradication, even if they are combined with chemoprophylaxis. On the other hand, mass chemoprophylaxis should provide a control of lethality and morbidity due to malaria. The authors define the mass prophylaxis concept, lay its basic principles and specifically the criteria used to select the available anti-malarial drugs. Then, they stress on the major set-backs such as P. falciparum resistance to amino-4-quinoleine, and drop of immunity in individuals receiving no chemoprophylaxis. Finally, they review the necessary conditions for the achievement of a mass chemoprophylaxis at a wide country level, namely: a determined policy with long term budget allowances, setting up of a specific organization and personnel training, community education at all levels, preliminary epidemiological surveys and strategical schemes suited to the various epidemiological patterns.

[Epidemiology of malaria, the 1st world-wide endemia. Various observations]. / Epidémiologie du paludisme, première endémie mondiale. Quelques notes.

Malaria is still the main worldwide endemia. More than one milliard of people live in some malaria infected areas. After having affected almost all parts of the continents, malaria, nowadays, is mainly limited to tropical and subtropical zones. There is not one single malaria but the disease offers four aspects according to the existence of four human plasmodial species, P. falciparum, P. vivax, P. ovale, P. malariae. P. falciparum is responsible for the more damageable effects on public health. It is the killing agent of tropical malaria. After a brief recall of the geographical distribution of the four human plasmodial species, the author reviews each link of the epidemiological chain: the pathogenic parasite, man as parasite reservoir, the anopheles as the vector in its relations with man and Plasmodium, receptive man regarding malarial infection, aspects of acquired immunity in the individual as well as in human groups of populations in endemic areas. These few up-to-date notes in malarial epidemiology may help to a better understanding of the endemicity levels, stable and unstable malaria, critic levels for transmission. A chapter deals with mathematical models for transmission. Rules for antimalarial control and reasons of the set backs of this control in tropical Africa are briefly reviewed.

[Supervision of the antibiotic therapy in tropical areas (author's transl)]. / Controle bactériologique de l'antibiothérapie en milieu tropical.

The use of antibiotics in tropical areas is coming up against many various problems. It is necessary to organize a supervision of the antibiotic therapy, which must be more severe. The diagnosis of bacterial diseases should be carried out in small laboratories, in rural regions. Microbiological researches, adapted to every country, are devoted to national laboratories. For the latter, collaborating regularly with international reference centres is very helpful. So it is easy to assure a continuous epidemiological surveillance of the major disease and to study bacteria, in order to find out resistant strains.