Anaes practice guidelines for vaccination against hepatitis B virus: impact on general practitioners.

INTRODUCTION: In September 2003, Agency for Accreditation and Evaluation in Health (ANAES) published its consensus recommendations for vaccination practices against hepatitis B virus (HBV), one objective of which was to decrease the risk of HBV transmission to those in the environments of patients who are carriers of the HBs antigen. The aim of our survey was to measure the awareness and application of these recommendations among general practitioners (GPs) in the Loiret region. PATIENTS AND METHODS: This retrospective survey analysed the decisions, using a semi-directed interview, made by all consenting GPs who, in 2004, had referred newly diagnosed HBs antigen-positive patients to the liver unit of the hospital of Orleans. RESULTS: Of the contacted GPs, 83% agreed to participate. Although only one-third of them were familiar with the recommendations, all identified the sexual partners and people living under the same roof as the patient targets for screening and/or vaccination. Also, 75% of the GPs had a consultation with some or all of the identified at-risk individuals in their patient's environment, but only 58% succeeded in vaccinating these at-risk people. Among the interviewed GPs, 71% were in favour of mass vaccination practices against HBV and all were in favour of vaccination targeting the at-risk individuals. CONCLUSION: Dissemination of the ANAES recommendations needs to be improved, even though the majority of the GPs included in the present study were in favour of mass vaccination against HBV and all were in favour of vaccination of at-risk individuals. However, one-third of the identified at-risk individuals eluded screening and/or vaccination, indicating the need for a specific organized program to make contact with these prone populations.

Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis--results of a nationwide survey.

BACKGROUND: Epidemiological data concerning hepatitis B are scarce in France. AIM: To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France. METHODS: Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. RESULTS: Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg-negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm(3) (P < 0.0001) and viral co-infection (P < 0.03). CONCLUSION: HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.

[Normal and pathological cardiac aging. Apropos of an exceptional case of longevity]. / Vieillissement cardiaque normal et pathologique. A propos d'un cas de longévité exceptionnelle.

Born in Arles on February 21st 1875, Madame J. C. was the oldest registered human being. She died on August 4th 1997 at the age of 122 years, the record for longevity probably for a long moment. Based on this unique case and a review of the literature, the authors describe the mechanical, physiological and clinical aspects of normal cardiac ageing. The diseases of the elderly which accelerate the process of physiological ageing are then reviewed. With its participation in left ventricular hypertrophy, left atrial dilatation and the increase in valvular stress, the decreased elasticity of the great arteries seems to be the essential factor.

Comparison of HCV RNA assays for the detection and quantification of hepatitis C virus RNA levels in serum of patients with chronic hepatitis C treated with interferon.

Detection and quantification of hepatitis C virus (HCV) RNA levels by using the standardized qualitative Amplicor HCV and quantitative Amplicor HCV Monitor assays (Roche Molecular Systems) were evaluated in 48 patients with chronic hepatitis C treated with interferon. Results were compared with an in-house reverse transcription and polymerase chain reaction (RT-PCR) assay and the branched DNA (bDNA) assay (Quantiplex, version 1.0, Chiron Diagnostics). Concordance of the qualitative results with the Amplicor HCV and in-house RT-PCR assays occurred in 82% of the samples. All but one of the discrepant specimens were found positive by the Amplicor HCV assay and negative by the in-house RT-PCR. Among the samples with HCV RNA levels measurable with the Amplicor HCV Monitor assay, 22% had HCV RNA titers below the detection limit of the Quantiplex assay. A statistically significant correlation was found between the 2 quantitative assays, although lower titers were obtained with the Amplicor HCV Monitor assay. More important, a good correlation was observed in the evolution of viremia as measured by the 2 assays during interferon therapy. During follow-up of interferon treatments, with the Amplicor HCV Monitor assay, persisting viremia was still detected in 27% of the patients who normalised alanine aminotransferase (ALT), emphasizing the bioclinical relevance of the assay. Pre-treatment serum HCV RNA levels above 10(5) copies/ml were found more frequently in nonresponders than in responders (76% vs. 44%; P < 0.05). Given their great sensitivity and the significant correlations, the Amplicor HCV qualitative and quantitative assays appear useful for the diagnosis and management of hepatitis C infection, and especially for monitoring of therapy.