Survey of delivery of prophylactic immunoglobulins following exposure to a measles case

In France, almost 23,000 cases of measles and 10 deaths have been reported between January 2008 and August 2012. French health authorities recommend delivery of human polyvalent immunoglobulins in the event of exposure to a measles case for some categories of unvaccinated persons (children under the age of 12 months, immunocompromised persons and pregnant women), within six days after exposure and following laboratory confirmation of the contact case. We carried out a postal survey among 368 French hospital pharmacies to evaluate the number of persons affected by this measure between 1 January 2010 and 31 August 2011, to describe the characteristics of these patients and to evaluate the application of the recommendations in terms of delay between exposure and immunoglobulin delivery, and confirmation of the contact case. The response rate to the survey was 73%. In total, 400 immunoglobulin deliveries were listed, most of them for children under the age of one year, and 84% of the 250 administrations with available information occurred within six days after exposure, as recommended. However, only 48% of the 209 treated contacts with available information were laboratory-confirmed when the immunoglobulins were delivered. This survey is the first evaluation of this recommendation since its introduction in 2005 and suggests that the recommendations may need to be updated.

[Short-term relationships between urban atmospheric pollution and respiratory mortality: time series studies]

Time series studies conducted in the field of air pollution aim at testing and quantifying short-term relations which can exist between daily air pollution levels and daily health effects. The method used for this type of survey has sometimes been misunderstood mainly because individual factors and indoor exposure to air pollutants were not taken into account. The adjustment on these individual confounding factors commonly used in classic epidemiologic studies (case-control studies, cohort studies) is not adequate to times series studies which are based on aggregate data. This is different for those factors that change over time according to the levels of air pollution (meteorological conditions, influenza epidemics, trend of health cases) which, when being analysed, must be taken into account either indirectly through time modelling or directly through non-linear modelling processes. During this last decade, numerous studies using the time series method have been published and have found short-term associations between daily levels of air pollution commonly observed and daily respiratory mortality. The consistency of the numerous results published in the international literature are more arguments in favour of non-confounding short-term relations between air pollution and respiratory mortality.

[Surveillance of short-term effects of urban air pollution on mortality. Results of a feasibility study in 9 French cities]

BACKGROUND

This study aims at quantifying air pollution effects on mortality and at evaluating the feasibility of a standardized epidemiological surveillance system of air pollution in 9 French cities.

METHODS

Data collection and analysis followed a standardized protocol. Data pollution depended on the development of local air quality surveillance networks (number of indicators, number of stations.). The Generalised Additive Models (GAM) were used to quantify the association between air pollution and mortality.

RESULTS

In the 9 studied areas, associations between all causes, cardiovascular and respiratory mortality, and air pollution indicators were observed. These associations were linear without threshold. Depending on the pollutants, excess in mortality related to an interquartile increase in acid-particulate pollution varied between 0.3 and 3.5% for total mortality, 0.5 and 6.3% for cardiovascular mortality, and between 0.1 and 12% for respiratory mortality. Photochemical air pollution varied between 0.4 and 7.3% for total mortality, 1.4 and 6.7% for cardiovascular mortality, and between 1.7 and 30.4% for respiratory mortality.

CONCLUSION

In spite of a standardized common protocol, some disparities, inherent to the local characteristics, were noted (length of time series, numbers of ambient urban stations selected and pollutants available.). Nevertheless, this pilot study showed that multicentric epidemiological monitoring of air pollution effects on health was feasible. Yet, this requires to validate the results obtained through a re-analysis of the mortality data on a longer period of study. It also requires to study the feasibility and the relevance of the use of other health indicators, such as hospital admissions.

[Relevance and feasibility of a surveillance system of the effects of atmospheric pollution]

New regulations on the quality of air together with the epidemiological results obtained in the last 10 years on the short-term effects of air pollution on health have led the InVS to set up a program of epidemiological surveillance in 9 French cities. The first phase of this program was dedicated to the study of feasibility of such a surveillance system. Metrological and health data collection was conducted at both local and national levels in order to obtain significant data in close collaboration with experts of each field. The analysis of the relationship between temporal variations of daily series of the two types of indicators have allowed to obtain dose-response relationships between air pollution and mortality. The organisational and technical feasibility of such a surveillance system was confirmed in the first phase of the program.

[Evaluation of biological impregnation of a population exposed to high concentration of arsenic in water supply, Ferrette, 1997]

BACKGROUND

The population of Ferrette has been exposed to well-water with arsenic (As) levels higher than legal threshold. The aim of this study was to assess the relationships between daily tap-water consumption, As quantities thus ingested and biological arsenical impregnation.

METHODS

The study was carried out on a sample of 100 people in the town of Ferrette and 100 people in the town of Seppois-le-Bas where the water quality is satisfactory. Ingested water and As were assessed by the mean of a food questionnaire. The quantity of ingested As was related to the body weight and compared to the tolerable daily intake (TDI) of 2 micrograms/kg/d. Biological impregnation was assessed by measuring out As in hair sample.

RESULTS

The daily ingested As intake of Ferrette population ranged from 0 to 32 micrograms/kg/d. One half of the population ingested more than 2 micrograms/kg/d. A quarter of the population ingested more than 4.3 micrograms/kg/d. 15% of Ferrette inhabitants yielded an As hair level higher than 0.1 ng/mg [IC95%: 8.7%-23.5%], versus 7% [IC95%: 2.9-13.9%] for the inhabitants of Seppois-le-Bas (p = 0.07). Among those who ingested an amount of As higher than the TDI, 19% were found to have detectable As hair levels, versus 9% for those who ingested less than the daily acceptable amount (p = 0.18).

CONCLUSION

One half of the population of Ferrette absorbed an As amount double to the TDI, evidencing the reality of the exposure. We did not find any statistically significant relation between the ingested As amount and biological As impregnation nor between exposure to water containing excessive As level and As biological impregnation.

[Association between air pollen concentrations and seasonal allergies: synthesis of epidemiological studies published between 1978 and 1995]

Many clinical studies have shown a causal link between exposure to pollens and clinical symptoms of atopy. However knowledge regarding the dose-response relationship between airborne pollen counts and the occurrence of clinical symptoms of seasonal pollinosis in the population, are not well known. The review of epidemiological studies published in this field for the last 15 years indicates that most epidemiological studies were carried out using a panel study design of well documented pollinosis subjects. These studies aim at estimating the correlation between daily airborne pollen counts measured by an aeropollinic surveillance network and clinical indicators characterising the health condition of the studied population. Nevertheless, because of many methodological weaknesses, especially regarding the methods of statistical analysis, the results of these studies do not allow to conclude that there is a short term association between airborne pollen counts and the incidence of symptoms of seasonal pollinosis. This field of research is a priority in order to assess the public health impact of pollens, and to use with efficacy the data collected by monitoring networks.

Cancer risk among workers in biomedical research

OBJECTIVE

This epidemiologic study was undertaken after a cluster of five cases of rare forms of cancer (bone sarcoma, non-Hodgkin's lymphoma) had been observed among biomedical research workers at the Pasteur Institute in Paris to ascertain whether their disease was connected with exposure during this research.

METHODS

A mortality study included 3765 people who worked at the Pasteur Institute between 1971 and 1986 and were followed until the end of 1987. Within this cohort a nested case-referent study included 23 cases of cancer [non-Hodgkin's lymphoma (6), multiple myeloma (1), leukemia (3), pancreatic cancer (7), bone cancer (3), brain tumor (3)], and four referents per case, matched for gender and year of birth.

RESULTS

Total mortality from cancer was less than expected, the standardized mortality ratio (SMR) being 72 for the men and 82 for the women. Among the women the proportion of pancreatic cancer cases was larger than expected [SMR 490, 95% confidence interval (95% CI) 158-1144], as was the number of brain cancer cases (SMR 239, 95% CI 48-696). Among the men, mortality from bone cancer was greater than expected (SMR 553, 95% CI 62-2006). In the nested case-referent study, more cases than referents had worked in the areas of molecular biology [odds ratio (OR) 7.1, 95% CI 1.5-33] and microbial genetics (OR 6.7, 95% CI 1.3-35). These cases especially included non-Hodgkin's lymphoma and bone cancer. Associated with this finding was the fact that more cases had used certain chemicals, including ethidium bromide, acrylamide, methylnitronitrosoguanidine and ethylmethanesulfonate, and radioactive compounds (essentially 32phosphorus).

CONCLUSIONS

As the products used are potent genotoxicants, the present findings suggest that work in biomedical research might well involve an increased risk of certain types of cancer; this conclusion should be balanced by the fact that two of the five index cases were included in the mortality study and four in the nested case-referent study.

Hairy cell leukaemia, occupation, and smoking

The roles of farm practices, occupational exposures to organic solvents, and ionizing radiation in the risk of hairy cell leukaemia (HCL) were examined in a French hospital-based multicentre case-control study including 291 cases (229 men and 62 women) and 541 controls (425 men and 116 women). No positive association was observed with occupations involving exposure to organic solvents or with self-declared exposures to solvents, but a significant association with self-reported exposure to petrol or diesel was found for men (OR = 1.5 CI95% [1.0-2.1]). No association with ionizing radiation was detected. Agriculture employment gave an odds ratio of 1.7 (CI95% [1.1-2.4]) for men and 2.7 (CI95% [1.1-6.7]) for women. Among men, the association seems to affect farmers rather than agricultural workers. Self-declared exposure to pesticides or bovine cattle breeding was related to HCL risk in both genders. Finally, a significant negative association with smoking was observed in men, with an inverse exposure-risk relationship odds ratios of 0.6, 0.5 and 0.2, respectively, for cumulative consumptions of < 10, 10-23 and > or = 24 pack-years), contrasting with an odds ratios clearly > 1 in women.

Incidence and risk factors for childhood brain tumors in the Ile de France

A case-control study investigating risk factors for childhood brain tumors was conducted in the Ile de France (Paris region). During a 2-year period (1985-1987) 109 newly diagnosed cases were identified and, of these, 75 could be interviewed. In the same region, 113 population controls, frequency-matched for year of birth, were interviewed. Odds ratios adjusted for child's age and sex and for maternal age were estimated for each risk factor present in utero or during childhood by conditional logistic regression. Statistically significant associations were found for the following risk factors: farm residence, cat scratches, home treated with pesticides, passive smoking, family history of cancer, antihistamine intake. Intake of vitamin supplements during childhood was associated with a decrease in risk. This study is part of a multicentric case-control study coordinated by the International Agency for Research on Cancer and its results will be compared for consistency, and pooled with those of other centers using the same protocol.