Effects of acupuncture on mental health of migraine patients: a systematic review and meta-analysis

BACKGROUND

Migraine is a neurological disease characterized by moderate to severe headache and various neurological symptoms. It is often cause mood and anxiety disorders that can seriously affect quality of life. Acupuncture has been claimed to have a role in treating neuropsychiatric disorders and is becoming increasingly popular. However, it remains unclear whether current evidence is sufficient to support acupuncture in improving mental health in migraine patients.

OBJECTIVES

This systematic review and meta-analysis aimed to investigate the effect of acupuncture on the management of pain and mood disorders in patients with migraine.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang Data Knowledge Service Platform for reports, conferences and academic papers published before January 1, 2022. Randomized controlled trials (RCTs) including acupuncture, sham acupuncture and medication for migraine were included. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis.

RESULT

Thirteen randomized controlled trials containing 1766 migraine patients were included in the present study, the results showed that compared with sham acupuncture and medication, acupuncture seemed to have advantage in improving SAS (WMD: -5.64;95% CI: -10.89, -0.39; p = 0.035) and SDS (WMD: -4.65; 95% CI: -9.25, -0.05; p = 0.048) in migraine patients. And it seems to be more effective in improving MH (SMD: 0.77; 95% CI: 0.19, 1.35; p = 0.009), VAS (SMD: -1.06; 95% CI: -1.73, -0.4; p = 0.002;) and MSQ (WMD: 4.76; 95% CI: 2.36, 7.15; p < 0.001) than sham acupuncture and medication.

CONCLUSION

The present results suggest that, compared with Western medicine and sham acupuncture, acupuncture seems to be able to effectively improve anxiety and depression in migraine patients.And it may be more effective in improving SF36-mental health, VAS and MSQ than shame acupuncture or Western medicine. The results of this study need to be verified by higher quality RCTs.

TEAS, DHEA, CoQ10, and GH for poor ovarian response undergoing IVF-ET: a systematic review and network meta-analysis

BACKGROUND

Assisted reproductive technology (ART) has brought good news to infertile patients, but how to improve the pregnancy outcome of poor ovarian response (POR) patients is still a serious challenge and the scientific evidence of some adjuvant therapies remains controversial.

AIM

Based on previous evidence, the purpose of this systematic review and network meta-analysis was to evaluate the effects of DHEA, CoQ10, GH and TEAS on pregnancy outcomes in POR patients undergoing in vitro fertilization and embryo transplantation (IVF-ET). In addition, we aimed to determine the current optimal adjuvant treatment strategies for POR.

METHODS

PubMed, Embase, The Cochrane Library and four databases in China (CNKI, Wanfang, VIP, SinoMed) were systematically searched up to July 30, 2022, with no restrictions on language. We included randomized controlled trials (RCTs) of adjuvant treatment strategies (DHEA, CoQ10, GH and TEAS) before IVF-ET to improve pregnancy outcomes in POR patients, while the control group received a controlled ovarian stimulation (COS) regimen only. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The surface under the cumulative ranking curve (SUCRA) was used to provide a pooled measure of cumulative ranking for each outcome.

RESULTS

Sixteen RCTs (2323 women) with POR defined using the Bologna criteria were included in the network meta-analysis. Compared with the control group, CoQ10 (OR 2.22, 95% CI: 1.05 to 4.71) and DHEA (OR 1.92, 95% CI: 1.16 to 3.16) had obvious advantages in improving the clinical pregnancy rate. CoQ10 was the best in improving the live birth rate (OR 2.36, 95% CI: 1.07 to 5.38). DHEA increased the embryo implantation rate (OR 2.80, 95%CI: 1.41 to 5.57) and the high-quality embryo rate (OR 2.01, 95% CI: 1.07 to 3.78) and number of oocytes retrieved (WMD 1.63, 95% CI: 0.34 to 2.92) showed a greater advantage, with GH in second place. Several adjuvant treatment strategies had no significant effect on reducing the cycle canceling rate compared with the control group. TEAS was the least effective of the four adjuvant treatments in most pooled results, but the overall effect appeared to be better than that of the control group.

CONCLUSION

Compared with COS regimen, the adjuvant use of CoQ10, DHEA and GH before IVF may have a better clinical effect on the pregnancy outcome of POR patients. TEAS needs careful consideration in improving the clinical pregnancy rate. Future large-scale RCTs with direct comparisons are needed to validate or update this conclusion.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022304723.

Effect of transcutaneous electrical acupoint stimulation on pregnancy outcomes in women with in vitro fertilization-embryo transfer: A systematic review and meta-analysis

Objective: The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer (IVF-ET), in order to provide evidence-based medical support. Methods: We searched the Cochrane Library, Embase, PubMed, Web of Science, SinoMed, and CNKI for relevant randomized controlled trials (RCTs) from inception to 31 May 2022, using the search terms "transcutaneous electrical acupoint stimulation," "TEAS," "in vitro fertilization-embryo transfer," "IVF-ET," "randomized controlled trial," and "clinical trials." The experimental group was treated with TEAS or combined with ovulation-inducing medication, and the control group was treated with mock TEAS (mTEAS), ovulation-inducing medication, or no intervention. The main outcome was the clinical pregnancy rate. Secondary outcomes were the embryo implantation rate, live birth rate, biochemical pregnancy rate, and number of oocytes retrieved. Stata15.1 software was used for data summary and analysis. Results: This review involved 15 RCTs and 4,281 participants. TEAS were superior to the control group for improving the clinical pregnancy rate [RR: 1.29, 95% CI: 1.19 to 1.40; p < 0.001; I² = 23.0%], embryo implantation rate [RR: 1.43, 95% CI: 1.22 to 1.69; p < 0.001; I² = 35.9%], live birth rate [RR: 1.33, 95% CI: 1.14 to 1.54; p < 0.001; I² = 47.3%], and biochemical pregnancy rate [RR: 1.15, 95% CI: 1.05 to 1.26; p = 0.003; I² = 49.1%], without significant heterogeneity. TEAS had no statistically significant effect on the number of oocytes retrieved as compared with the control group, and the heterogeneity was high [SMD: 0.34, 95% CI: -0.04 to 0.72; p = 0.081; I² = 77.6%]. We performed subgroup analysis based on the sample size, interventions and intervention time-point. The results showed that the sample size had no effect on the results. There was no significant difference between TEAS and ovulation-inducing medication in the clinical pregnancy rate or the embryo implantation rate. In addition, TEAS did not significantly increase the embryo implantation rate or the live birth rate, compared with no intervention. In terms of safety, mild allergic symptoms were found in both the experimental group and the control group. Conclusion: In general, existing evidence supports the potential value of TEAS as an adjunctive treatment for improving pregnancy outcomes. High-quality, large-sample RCTs are needed to further support this conclusion. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334892, identifier PROSPERO CRD42022334892.

Chinese herbal medicine xuebijing injection for acute pancreatitis: An overview of systematic reviews

Background: At present, a number of systematic reviews (SRs) on Xuebijing injection (a patent in China) in the treatment of acute pancreatitis (AP) or severe acute pancreatitis (SAP) have been published. However, the quality of evidence is uneven and has not been comprehensively evaluated.

Aim: We evaluated the efficacy of Xuebijing injection for AP/SAP through an overview of SR, and to provide a scientific basis for its effectiveness and safety.

Methods: We searched Cochrane Library, Embase, PubMed, SinoMed, CNKI, Wanfang, and VIP comprehensively. The retrieval period from inception to 30 November 2021, and the two reviewers independently complete the literature retrieval, data extraction and evaluation. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) were used to evaluate the methodological quality and reporting quality of the SRs, respectively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality grading of outcomes and the risk of bias in SRs was evaluated by ROBIS Tool. Finally, the RCTs involved in SRs were synthesized. Stata15.1 was used for quantitative analysis of total effectiveness rate, time until relief of abdominal pain, time until relief of abdominal distension, and serum amylase level.

Results: Nine eligible SRs were included, including 92 RCTs and 6,837 participants. The quality of SRs was relatively good, and the manuscript structures were relatively complete. However, the methodological quality of SRs was low or critically low. RoB rated 5 SRs as low risk of bias and 4 SRs as high risk of bias. In GRADE, a total of 47 results were included in the 9 SRs, of which 5 results (10.64%) were moderate quality, 22 results (46.81%) were low quality, and 20 results (42.55%) were very low quality. The results of data synthesis showed that Xuebijing injection combined treatment increased the total effectiveness rate of AP patients (RR = 1.19, 95% CI 1.17–1.23, p < 0.0001), and there was no heterogeneity between studies (I² = 0.0%, p = 0.589). Compared with the control group, Xuebijing injection group shortened the abdominal pain and distension relief time in AP patients (WMD = −1.69, 95% CI −1.88–−1.50, p < 0.0001; WMD = −1.48, 95% CI −1.74–−1.23, p < 0.0001), with high heterogeneity (I² = 84.3%, p = 0.000; I² = 72.2%, p = 0.000). Serum amylase level was also reduced (WMD = −2.06, 95% CI −2.47–−1.64, p < 0.0001), with significant heterogeneity (I² = 71.6%, p = 0.000). A total of one SR reported adverse drug reaction (ADR), no ADRs were observed in the control group.

Conclusion: Although the quality of the evidence is not high, it can still reflect the clinical value of Xuebijing injection as an analgesic and anti-inflammatory traditional Chinese medicine in the treatment of AP/SAP. Therefore, future clinical studies should focus on the long-term efficacy and adverse reactions of drugs.

Systematic Review Registration: (website), identifier (registration number).

An Overview of Systematic Reviews of Moxibustion for Knee Osteoarthritis

Background

Currently, many systematic reviews (SRs) of moxibustion as a treatment of KOA have been published. However, the evidence of different SRs of moxibustion to treat KOA has not been comprehensively evaluated.

Aim

This overview aimed to evaluate the existing results and provide scientific evidence of the effectiveness and safety of moxibustion in the treatment of KOA.

Methods

We conducted a comprehensive search of Embase, PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang, VIP, and other databases until October 31, 2021. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) was used to assess the methodological quality of SRs. Preferred Reporting Item for Systematic Reviews and Meta-Analyses was used to evaluate the reporting quality, and the risk of bias in SRs was evaluated by ROBIS Tool. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to determine the strength of evidence and conducted a meta-analysis of the total effectiveness rate.

Results

Finally, 10 qualified SRs were included, including 57 randomized controlled trials and 5,149 participants. All SRs evaluated by AMASTAR-2 had more than one critical deficiency, so all SRs were rated as critically low. In the PRISMA checklist, the manuscript structures of the included SRs were relatively complete. Including four SRs with a low risk of bias and six with a high risk of bias using the ROBIS tool. In GRADE, two items (6.25%) were rated as high quality, three (9.37%) as medium quality, 17 (53.12%) as low quality and 10 (31.25%) as very low quality. A re-meta-analysis showed that moxibustion and moxibustion combined treatment improved the total effectiveness rate in knee osteoarthritis (risk ratio = 1.17, 95% confidence interval 1.13–1.21, P < 0.001 and risk ratio = 1.13, 95% CI: 1.04–1.23, P < 0.001), with low heterogeneity (I² = 36.3%, P = 0.020, and I² = 0.0%, P = 0.956). A total of eight SRs reported adverse events, and no serious adverse events occurred in the moxibustion group and control group.

Conclusion

Moxibustion seems to be effective in treating KOA. Four SRs reported 10 common discomfort symptoms caused by moxibustion, and these adverse events can spontaneously subside, even can be avoided, therefore, moxibustion for KOA appears to be safe. However, the reliability of the results is reduced by the high risk of bias of the original studies and the low methodological quality of SRs. Therefore, future studies should pay more attention to the quality of the original study and the evidence quality of the SRs to provide more powerful and scientific evidence of the effectiveness and safety of moxibustion treatment of KOA.

Research Hotspots and Trends in Music Therapy Intervention for Patients With Dementia: A Bibliometrics and Visual Analysis of Papers Published From 2010 to 2021

BACKGROUND

As a serious public health problem, dementia has placed a heavy burden on society and families. Evidence suggests that the use of music therapy as a non-pharmacological intervention has certain advantages with respect to reducing the behavioral and psychological symptoms of dementia (BPSD) and improving the cognition and mental status of dementia patients. However, research trends and hotspots regarding music therapy intervention for dementia analysis have not been systematically studied via bibliometric analysis.

METHODS

We searched the Web of Science Core Collection (WoSCC) for texts published between January 1, 2010, and October 31, 2021, and visualized country, institution, journal, keyword co-occurrence, keyword emergence and keyword clustering.

RESULTS

A total of 217 articles from the WoSCC database were analyzed. In this research field, the annual number of publications has generally shown a slowly increasing trend, and the United States has the most publications and the most frequent cooperation among countries. University College London (UCL) has the most extensive influence among research institutions. Among articles, those published in the JOURNAL OF ALZHEIMER'S DISEASE were the most numerous, with 20 such articles being published, accounting for 9.22% (20/217) of the total. Comprehensive analysis of five clusters via biclustering shows that the research hotspots in this field during the past 11 years have mainly focused on the autobiographical memory, cognitive function, mental state and BPSD of dementia patients.

CONCLUSION

This study conducted a bibliometric and visual analysis of relevant studies concerning music therapy intervention for dementia patients. Psychological problems faced by dementia patients and the topics of quality of life, individualized music therapy, the mental state of caregivers and other related topics may be important research directions in the future. Therefore, the question of how to develop standardized research protocols and identify unified efficacy evaluation indicators should be a focus of and difficulty for future research.

Acupuncture for Relieving Abdominal Pain and Distension in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Background: Clinical evidence suggests that acupuncture is effective for relieving abdominal pain and distension in acute pancreatitis (AP). However, there is a lack of systematic reviews and meta-analyses that provide high-quality evidence of the efficacy and safety of acupuncture in this context. Aim: To assess the efficacy and safety of acupuncture for relieving abdominal pain and distension in AP. Methods: We searched the PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and China Biomedical Literature databases. Randomized controlled trials of acupuncture plus routine treatment (RT) vs. RT alone or RT plus sham/placebo acupuncture were included. Primary outcomes included total effectiveness rate, VAS scores for abdominal pain and distension, and time until relief of abdominal pain and distension. Secondary outcomes included time until recovery of bowel sound, time until first defecation, length of hospital stay, and APACHE II score. Results: Nineteen eligible original studies (n = 1,503) were included. The results showed that acupuncture in combination with RT had a significant advantage in terms of increasing the total effectiveness rate [risk ratio: 1.15; 95% confidence interval (CI): 1.06-1.24; P = 0.001]. Acupuncture also reduced the VAS score for abdominal pain [weighted mean difference (WMD): -1.45; 95% CI: -1.71 to -1.19; P < 0.0001] and the VAS score for abdominal distension (WMD: -0.71; 95% CI: -1.04 to -0.37; P < 0.0001) in patients with AP. Other results also showed the efficacy of acupuncture. One study reported adverse events after acupuncture. Conclusion: Acupuncture in combination with RT has a better effect than RT alone for relieving abdominal pain and distension in AP. More rigorous studies are needed to confirm this result. Systematic Review Registration: PROSPERO CRD42019147503 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=147503).

Evaluation of a web-based self-reporting method for monitoring international passengers returning from an area of emerging infection

OBJECTIVES

Emerging infectious diseases are a public health issue of international concern. Identifying methods to limit their expansion is essential. We assessed the feasibility of a screening strategy in which each traveler would actively participate in the screening process after an intercontinental flight by reporting their own health status via a web-based self-administered questionnaire.

PATIENTS AND METHODS

In 2015 and 2017, we invited passengers arriving at or departing from Pointe-à-Pitre international airport to answer an online health questionnaire during the four days following their arrival from or at Paris-Orly international airport. SPIRE 1 was intended for passengers arriving at Pointe-à-Pitre and was conceived as a pilot study. SPIRE 2 was an improved version of SPIRE 1 and consisted in three parts, which permitted to further assess the benefits of pre-flight request and email follow-up. Endpoints were the connection rates and response rates to online health questionnaire.

RESULTS

For SPIRE 1, 4/1038 travelers (0.4%) completed the two steps of the online health questionnaire. In SPIRE 2, response rates ranged from 3/1059 (0.3%) to 19/819 (2.3%). Response rates were significantly better when passengers were approached before their flight.

CONCLUSIONS

The yield of an online health questionnaire was unexpectedly low.

AB0474 CAROTID CONTRAST ENHANCED ULTRASOUND IN CASES OF TAKAYASU ARTERITIS COMPLICATED WITH BEHCET’S DISEASE

Background:

Carotid contrast enhanced ultrasound (CEUS) is used for diagnosis and activity determination of patients with Takayasu’s arteritis (TA). However, very little is known about the carotid CEUS features of TA complicated with Behcet’s disease (BD).

Objectives:

This study reports the carotid CEUS features in cases of TA complicated with BD (TBD).

Methods:

A total of 10 carotid CEUS examinations were performed on 4 patients of TBD. 10 TA patients complicated with no rheumatoid disease were included as control group. For each carotid artery lesion, the carotid CEUS features was graded as follows: Grade 0, artery wall shows no microbubbles, Grade 1, artery wall shows limited or moderate microbubbles, Grade 2, artery wall shows severe microbubbles.

Results:

2/10 patients in TBD group has oral ulcer during the CEUS examination, while all the other patients included in our study showed no clinical symptoms related to active TA or BD. The carotid wall thickness was greater of CEUS grade 2 than grade 1 in both group(TBD: 2.62±0.74mm vs 1.66±0.22mm,p=0.001; TA:1.84±0.31mm vs 1.53±0.5mm,p=0.136). The carotid wall thickness was significantly greater in TBD group than TA group, but there was no significant differences between the two groups in clinical data and CEUS grade (table 1).

Table 1.

Clinical data and carotid CEUS features of both groups

TBDTApAge (year)32.5±3.4430.5±9.20.487Male320.605ESR (mm/h)4(2, 10)7(3.5, 11)0.406CRP (mg/L)6.42(0.55, 15.38)0.58(0.44, 5.05)0.168Wall thickness (mm)2.10±0.701.67±0.440.030CEUS grade 29120.527

Conclusion:

This study first shows carotid CEUS features in cases of TA complicated with BD, which may help with the comprehensive treatments of the disease.

Disclosure of Interests: :

None declared

The French Infectious Diseases Society's readiness and response to epidemic or biological risk-the current situation following the Middle East respiratory syndrome coronavirus and Ebola virus disease alerts

CONTEXT

In 2012, the French Infectious Diseases Society (French acronym SPILF) initiated the "Coordination of epidemic and biological risk" (SPILF-COREB - Emergences [SCE]) group to support the readiness and response of healthcare workers (HCWs) to new alerts.

OBJECTIVE

To present the SCE group, its functioning, and the main support it provided for frontline HCWs.

METHODS

A multidisciplinary group of heads of infectious disease departments from reference hospitals was created to build a network of clinical expertise for care, training, and research in the field of epidemic and biological risk (EBR). The network developed a set of standardized operational procedures (SOPs) to guide interventions to manage EBR-suspect patients.

RESULTS

A working group created the SOP aimed at frontline HCWs taking care of patients. Priority was given to the development of a generic procedure, which was then adapted according to the current alert. Five key steps were identified and hierarchized: detecting, protecting, caring for, alerting, and referring the EBR patient. The interaction between clinicians and those responsible for the protection of the community was crucial. The SOPs validated by the SPILF and its affiliates were disseminated to a wide range of key stakeholders through various media including workshops and the SPILF's website.

CONCLUSION

SPILF can easily adapt and timely mobilize the EBR expertise in case of an alert. The present work suggests that sharing and discussing this experience, initiated at the European level, can generate a new collective expertise and needs to be further developed and strengthened.

Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information?

OBJECTIVE

In France, tuberculosis surveillance is based on mandatory notification (MN) of cases. However, the MN does not allow the full description of cases, and underreporting limits data interpretation. Aiming at better describing the cases of tuberculosis, the hospital record database (PMSI) was analyzed.

PATIENTS AND METHOD

Incident cases of active pulmonary tuberculosis identified in 2010 in France in the PMSI were included and their characteristics were compared with those of the cases identified through the MN.

RESULTS

In 2010, 5158 incident cases of pulmonary tuberculosis were identified in the PMSI. The mean duration of hospitalization was higher for cases considered contagious — at least one positive test result on pulmonary sample — (22 vs 13 days, P < 0.001). Among all cases, 5% were infected by HIV. Death was reported for 4% of cases. The number of pulmonary TB cases reported in the MN was 3781 in 2010. PMSI data by sex, region of residence and month of diagnosis were similar with those of the MN but patients were older in the PMSI (52 vs 47 years, P < 0.001). Considering the PMSI as exhaustive, sensitivity of the MN was estimated at 73.3% in 2010.

CONCLUSION

PMSI data were compatible with those of the MN and the estimation of the sensitivity was close to other French studies. PMSI can be considered as an interesting tool aiming at improving our knowledge about tuberculosis (TB) cases and strengthening awareness where the sensitivity of the MN is low.

Impact of the BCG vaccination policy on tuberculous meningitis in children under 6 years in metropolitan France between 2000 and 2011

In France, Bacillus Calmette–Guérin (BCG) vaccination by multipuncture device was withdrawn in 2006. In 2007, universal mandatory BCG vaccination was replaced by vaccination of high-risk children. To evaluate the impact of these changes on tuberculous meningitis (TBM) epidemiology, data on culture-positive and culture-negative (or unknown microbiological result) TBM in ≤5 years olds were collected from 2000–2011. Ten culture-positive and 17 culture-negative TBM cases were identified, with an annual incidence rate ranging from 0.16 to 0.66 cases per 10 million inhabitants. The average annual numbers of TBM cases were 2.7 and 1.8 from 2000–2005 and 2006–2011, respectively. In Ile-de-France where all children are considered at risk, the overall incidence rates were 1.14 and 0.29 per million for the two periods. In other regions where only at-risk children are vaccinated since 2007, rates were 0.30 and 0.47, respectively. None of these differences were significant. Annual incidence rates for each one year age group cohort were comparable before and after changes. Childhood TBM remains rare in France. No increase in incidence was observed after changes in BCG vaccination strategy. Ongoing surveillance should be maintained, as a slight increase in TBM in the coming years remains possible, in the context of suboptimal vaccination coverage of high-risk children.

Epidemiologic characteristics associated with ST23 clones compared to ST1 and ST47 clones of Legionnaires disease cases in France

In France, approximately 1200 cases of Legionnaires disease (LD) are reported annually, and isolates are available for approximately 20% of cases identified since 2000. All Legionella pneumophila serogroup 1 (sg1) isolates are characterized by sequence-based typing at the National Reference Centre. LD cases caused by L. pneumophila sg1 reported from 2008 through 2012 were considered for the study. Our study objective was to describe cases according to their sequence type (ST). We also constructed multivariable modified Poisson regression models to estimate the incidence rate ratio (IRR) and to identify characteristics potentially associated with ST23 clones compared to ST1 and ST47 clones. We studied 1192 patients infected by ST1 (n = 109), ST23 (n = 236), ST47 (n = 123) or other STs (n = 724). The geographic distribution of the ST23 cases across the country was significantly different compared to other ST groups. This genotype was significantly associated with the absence of corticosteroid therapy compared to ST1 (IRR = 0.56; p 0.016). Concerning exposure, the ST23 genotype was significantly less associated with hospital-acquired infections compared to ST1 (IRR = 0.32; p 0.001), but it was more associated with infections acquired in hospitals and elderly settings compared with ST47. Finally, the ST23 genotype was less frequently associated with travel than other STs. Despite the large number of cases of ST23 infection, we did not identify any characteristics specific to this ST. However, we identified independent associations between ST1 and nosocomial transmission and steroid therapy. These findings should encourage further exploration, especially in terms of environmental diffusion, strain virulence and host factors.

First cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013

In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before symptom onset. Contact tracing identified a secondary case in a patient hospitalised in the same hospital room. No other cases of MERS-CoV infection were identified among the index case’s 123 contacts, nor among 39 contacts of the secondary case, during the 10-day follow-up period.

Treatment outcome monitoring of pulmonary tuberculosis cases notified in France in 2009

The proportion of patients considered to be cured is a key indicator to assess national tuberculosis (TB) control. In France, TB treatment outcome monitoring was implemented in 2007. This article presents national results on treatment outcome among patients with pulmonary TB reported in France in 2009 and explores determinants of potentially unfavourable outcome. Information on treatment outcome was reported for 63% of eligible pulmonary cases of whom 70% had a successful outcome. In a multivariate analysis, potentially unfavourable outcome (17%), compared to treatment success, was significantly associated with being male, born abroad and having lived in France for less than 10 years, being in congregate settings when treatment was initiated, or having a previous history of anti-TB treatment. Enhanced awareness of treatment outcome monitoring is essential to improve the coverage and the quality of information. Earlier diagnosis and improved management of the disease in the elderly may reduce death due to TB. The high proportion of potentially unfavourable outcomes should be further investigated as they may require additional vigilance and/or actions in term of efforts of TB control in some population groups.

Treatment outcome monitoring of pulmonary tuberculosis cases notified in France in 2009

The proportion of patients considered to be cured is a key indicator to assess national tuberculosis (TB) control. In France, TB treatment outcome monitoring was implemented in 2007. This article presents national results on treatment outcome among patients with pulmonary TB reported in France in 2009 and explores determinants of potentially unfavourable outcome. Information on treatment outcome was reported for 63% of eligible pulmonary cases of whom 70% had a successful outcome. In a multivariate analysis, potentially unfavourable outcome (17%), compared to treatment success, was significantly associated with being male, born abroad and having lived in France for less than 10 years, being in congregate settings when treatment was initiated, or having a previous history of anti-TB treatment. Enhanced awareness of treatment outcome monitoring is essential to improve the coverage and the quality of information. Earlier diagnosis and improved management of the disease in the elderly may reduce death due to TB. The high proportion of potentially unfavourable outcomes should be further investigated as they may require additional vigilance and/or actions in term of efforts of TB control in some population groups.

Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France

OBJECTIVE

To analyse diagnostic delay in tuberculosis (TB) patients.

DESIGN

Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom history and health-seeking trajectories.

RESULTS

Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR 0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014) and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001).

CONCLUSION

TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.

Assessing BCG vaccination coverage and incidence of paediatric tuberculosis following two major changes in BCG vaccination policy in France

Binary file ES_Abstracts_Final_ECDC.txt matches

Assessing BCG vaccination coverage and incidence of paediatric tuberculosis following two major changes in BCG vaccination policy in France

We report data on BCG vaccination coverage and paediatric tuberculosis (TB) incidence collected after the disappearance of the multipuncture device for BCG vaccination in January 2006 and the shift from universal to targeted vaccination in July 2007 in France.Vaccination coverage estimates in children for whom BCG is recommended allow assessing whether the recommendations are followed by doctors and/or accepted by the target population. In January and February 2006, BCG sales to the private sector in Îlede-France region were 74.2% and 41.3% of the ones for the same months the previous year. Total sales in 2006 amounted to 57.3% of those in 2005. Coverage decreased immediately after withdrawal of the multipuncture device, and remained generally insufficient in high risk children in the following years. However,the impact on paediatric TB incidence in 2008 seems very limited, although the duration of follow-up is still short. Training of doctors in intra-dermal vaccination and communication on the new vaccination policy should be strengthened

Cluster of Legionnaires' disease associated with a public whirlpool spa, France, April-May 2010

In May 2010, a cluster of three cases of Legionnaires' disease was identified in France. The results of the epidemiological, environmental and microbiological investigations allowed the rapid identification of a public whirlpool spa as the most probable source of contamination and the implementation of appropriate control measures. This investigation has stressed the need for good cooperation between partners and the importance of the molecular analysis of Legionella strains.

Cluster of Legionnaires´ disease associated with a public whirlpool spa, France, April – May 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

Management and treatment outcomes of tuberculous patients, eastern Paris, France, 2004

BACKGROUND

France was one of the few European countries without a national tuberculosis (TB) treatment outcome monitoring system until 2007.

OBJECTIVE

To examine TB management and treatment outcomes in the eastern Paris region, and to identify patient- and management-dependent factors affecting treatment outcome.

METHODS

This retrospective study focused on all cases of microbiologically confirmed Mycobacterium tuberculosis cases diagnosed in 2004 in the eastern Paris region, one of the areas of France with the highest frequency of TB.

RESULTS

Treatment outcomes of 629 identified cases (males 69.6%, median age 37 years, socio-economically disadvantaged 44%, foreign-born 78%) were as follows: treatment success 70.1% (95%CI 66.5-73.7), treatment interruption 4.9% (95%CI 3.2-6.6), loss to follow-up 15.0% (95%CI 12.2-17.8), death 5.7% (95%CI 3.9-7.9), transfers 4.3% (95%CI 3.5-5.1). Non-completion of treatment was associated with sputum smear positivity, injection drug use, non-adherence and irregular follow-up in univariate analysis, and with irregular follow-up and non-adherence in multivariate analysis. Duration of TB treatment and follow-up medical visits were not applied as recommended in more than a third of cases.

CONCLUSION

The treatment success rate observed in this study (70.1%) is below the World Health Organization target of 85%, and requires the implementation and evaluation of interventions to increase treatment success rates.

[Legionnaire's disease: surveillance in France in 2005]

Legionnaire's disease is a recently described infection and surveillance in France was implemented in 1987. In 2005, 1,527 cases were notified corresponding to a population incidence rate of 2.5 per 100,000. The median age of cases was 61 years [5-100] and the male to female sex ratio was 3.0. The case fatality rate was 11%. One or more risk factors were identified for 1,084 (71%) cases. The majority of cases (91%) was diagnosed by urinary antigen detection and a strain was identified in 276 cases (18%). Legionella pneumophila serogroup 1 infection was confirmed in 95% of cases. A specific exposure during the incubation period was reported for 39% of cases. Travel exposure was reported for 17% and hospital exposure for 7%. Multiple clusters and outbreaks were investigated. The largest one reported was identified in the north Lyon with 34 cases. Since 1997 the incidence of LD has steadily increased. This probably suggests a better detection of cases and an improvement in the surveillance system. In recent years, several new measures concerning prevention and control were implemented. However these efforts must continue particularly in the research domain to improve knowledge of the disease, in order to limit its impact on exposed populations.

Clusters of travel-associated Legionnaires’ disease in Italy, Spain and France, July 2002 - June 2006

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Tuberculosis in European cities: establishment of a patient monitoring system over 10 years in Paris, France

BACKGROUND

Tuberculosis (TB) is a persistent public health problem in European cities. France has been unable to report on treatment outcomes until now, and it is not known whether the World Health Organization (WHO) target cure rate of 85% has been met.

METHODS

All patients placed under treatment in four hospitals and five out-patient Social Medical Centres in Paris were followed up between 1996 and 2005. Patient monitoring and evaluation were performed using a new software programme, TB-INFO.

RESULTS

In a cohort of 1127 patients, 76% had pulmonary TB, of whom 39% were smear-positive, 81% were foreign-born and 9.3% were human immunodeficiency virus positive. At the end of the follow-up, 16% were cured and 54% had completed treatment. Among the 1118 non-multidrug-resistant patients, these percentages were 17% and 46%, respectively, for smear-positive pulmonary patients. Some patients died (1.9%) or failed treatment (0.1%), but many more defaulted (20.5%) as they interrupted treatment (1.5%), were lost to follow-up (19.5%) or were transferred out (7.9%).

CONCLUSIONS

This 10-year follow-up of TB patients, managed with TB-INFO software, shows that a patient monitoring system can be implemented in France, providing essential information. Treatment success in this cohort of patients was far below the WHO target.

[Factors associated with mortality in Legionnaires' disease, France, 2002-2004]

Risk factors for Legionnaires' disease are well known (older age, smoking, or immunosuppression), however, the factors associated with mortality are less documented. A retrospective analysis based on cases notified between 2002 and 2004 was conducted in France to identify these factors.

METHOD

Cases were identified through mandatory notifications sent to the Institut de veille sanitaire, France. Factors associated with mortality were identified using a logistic regression analysis.

RESULTS

Three thousand two hundred sixty-seven cases of Legionnaire's disease were notified during the study period and the evolution was documented for 85% of the cases (2.791). Three hundred seventy-seven deaths (13.5%) were notified. 72.5% of the patients were men and the median age was 61. The multivariate analysis applied to patients under 60 years revealed that cancer or hemopathy (OR=6.4 CI95% 3.6-11.2), underlying renal disease (OR=3.2 CI95% 1.0-9.9), or alcohol abuse (OR=2.2 CI95% 1.1-4.4) were associated with mortality. For older patients (>60 years) factors linked to mortality were: cancer/hemopathy (OR=1.8 CI95% 1.2-2.6), underlying renal disease (OR=3 CI95% 1.4-6.4), underlying cardiac disease (OR=2.4 CI95% 1.4-4), alcohol abuse (OR=2.4 CI95% 1.2-5.2), immunosuppression (OR=1.7 CI95% 1.1-2.6), nosocomial acquisition of the disease (OR=2.0 CI95% 1.3-3), or infection acquired in nursing home residents (OR=2.4 IC 95% 1.6-3.6).

CONCLUSION

These preliminary results further describe Legionnaires' disease and its mortality. However, they should be confirmed by carefully conducted prospective analysis. The description of LD patients at high risk of death will contribute to better prevention measures.

Épidémiologie de la tuberculose en France en 2005

This article presents results on cases of tuberculosis disease notified in France in 2005 by mandatory notification. In 2005, a total of 5,374 cases were notified in France, representing a rate of 8.9 cases per 100,000. The notification rate per 100,000 was below 10 in all French regions, except the Ile-de-France and French Guyana (with respective rates of 19.7/10(5) and 44.0/10(5)). Notification rates were higher in some population groups such as people born abroad (41.5/10(5)), especially those born in sub-Saharan Africa (160/10(5)), and those recently (<2 years) arrived in France (251/10(5)), in homeless people (214/10(5)), and in persons aged 80 years and over (21.7/10(5)). Pulmonary tuberculosis accounted for 73% of notified cases, 79% of which were contagious (positive direct examination of sputum, positive culture). Results from the notification of tuberculosis disease in 2005 indicate a continuing decrease of incidence in France. However, the high incidence in some population groups requires adapting public health actions to the needs of population groups more exposed to tuberculosis.

[Principles of an outbreak investigation in public health practice]

An outbreak (or epidemic) is a higher number of cases of a given disease in a given population and time interval. A timely investigation has for aim to identify the source and vehicle of the outbreak and provides unique opportunities to better understand its occurrence and the role of contributing risk factors to implement the most appropriate measures to control it and prevent further recurrences. The investigation of an outbreak is based on a multidisciplinary approach (clinical, epidemiological, environmental, and microbiological) with a descriptive and analytical (hypothesis testing) phase. In this article, we describe the methodological approach of a field outbreak investigation illustrated by examples taken from our experience. The investigation includes the following steps: establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place, and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community. The investigation of an outbreak is an evolving process: information gathered or conclusions made at a given stage must be fully used for following steps. The social, institutional, and political background associated with outbreaks usually makes their investigation complex and should be taken into account. The earlier the outbreak is detected and investigated in close relation with public health authorities, the greater will be the potential preventive impact of control measures.

An evaluation of data quality in a network for surveillance of Mycobacterium tuberculosis resistance to antituberculosis drugs in Ile-de-France region-2001-2002

We evaluated the French Azay-Mycobacteria network for surveillance of Mycobacterium tuberculosis drug resistance by matching data with those collected through the mandatory notification (MNTB). Sensitivity of Azay was 96% by capture-recapture analysis. Cases reported to MNTB were more often smear-positive than non-reported cases. Concordance of data collected for common cases was excellent for a majority of variables (k > 0.79), excepted for tuberculosis site (k = 0.52). These results suggest a good quality of the network.

Outbreak of legionellosis suspected to be related to a whirlpool spa display, September 2006, Lorquin, France

Twelve cases of legionellosis in the small town of Lorquin, district of Moselle, northeast France, were identified by the local health authority in charge of legionellosis surveillance in September 2006.