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1.  Molecular Epidemiology of Carbapenem Non-Susceptible Acinetobacter baumannii in France 
PLoS ONE  2014;9(12):e115452.
Carbapenem-resistant Acinetobacter baumannii have emerged globally. The objective of this study was to investigate the epidemiology, clonal diversity and resistance mechanisms of imipenem non-susceptible A. baumannii isolates in France. Between December 2010 and August 2011, 132 notifications were collected, including 37 outbreaks corresponding to 242 cases (2 to 55 per cluster). Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on 110 non-repetitive isolates. Gene blaOXA-23 was the most frequently detected (82%), followed by blaOXA-24 (11%) and blaOXA-58 (7%). Eleven sequence types (ST) were distinguished, among which sequence types ST1, ST2 (64%), ST20, ST25, ST85 and ST107. Isolates from epidemiological clusters had the same ST and resistance genes, indicating probable transmission within centres. In contrast, PFGE types of isolates differed among centres, arguing against transmission among centers. This study provides the first epidemiological snapshot of the population of A. baumannii with reduced susceptibility to carbapenems from France, and further underlines the predominance of international clones.
doi:10.1371/journal.pone.0115452
PMCID: PMC4269441  PMID: 25517732
2.  Multicenter Outbreak of Infections by Saprochaete clavata, an Unrecognized Opportunistic Fungal Pathogen 
Vaux, Sophie | Criscuolo, Alexis | Desnos-Ollivier, Marie | Diancourt, Laure | Tarnaud, Chloé | Vandenbogaert, Matthias | Brisse, Sylvain | Coignard, Bruno | Dromer, Françoise | Garcia-Hermoso, Dea | Blanc, Catherine | Hoinard, Damien | Lortholary, Olivier | Bretagne, Stéphane | Thiolet, Jean-Michel | de Valk, Henriette | Courbil, Rémi | Chabanel, Anne | Simonet, Marion | Maire, Francoise | Jbilou, Saadia | Tiberghien, Pierre | Blanchard, Hervé | Venier, Anne-Gaëlle | Bernet, Claude | Simon, Loïc | Sénéchal, Hélène | Pouchol, Elodie | Angot, Christiane | Ribaud, Patricia | Socié, G. | Flèche, M. | Brieu, Nathalie | Lagier, Evelyne | Chartier, Vanessa | Allegre, Thierry | Maulin, Laurence | Lanic, Hélène | Tilly, Hervé | Bouchara, Jean-Philippe | Pihet, Marc | Schmidt, Aline | Kouatchet, Achille | Vandamme, Yves-Marie | Ifrah, Norbert | Mercat, Alain | Accoceberry, Isabelle | Albert, Olivier | Leguay, Thibaut | Rogues, Anne-Marie | Bonhomme, Julie | Reman, Oumédaly | Lesteven, Claire | Poirier, Philippe | Chabrot, Cécile Molucon | Calvet, Laure | Baud, Olivier | Cambon, Monique | Farkas, Jean Chistophe | Lafon, Bruno | Dalle, Frédéric | Caillot, Denis | Lazzarotti, Aline | Aho, Serge | Combret, Sandrine | Facon, Thierry | Sendid, Boualem | Loridant, Séverine | Louis, Terriou | Cazin, Bruno | Grandbastien, Bruno | Bourgeois, Nathalie | Lotthé, Anne | Cartron, Guillaume | Ravel, Christophe | Colson, Pascal | Gaudard, Philippe | Bonmati, Caroline | Simon, Loic | Rabaud, Christian | Machouart, Marie | Poisson, Didier | Carp, Diana | Meunier, Jérôme | Gaschet, Anne | Miquel, Chantal | Sanhes, Laurence | Ferreyra, Milagros | Leibinger, Franck | Geudet, Philippe | Toubas, Dominique | Himberlin, Chantal | Bureau-Chalot, Florence | Delmer, Alain | Favennec, Loïc | Gargala, Gilles | Michot, Jean-Baptiste | Girault, Christophe | David, Marion | Leprêtre, Stéphane | Jardin, Fabrice | Honderlick, Pierre | Caille, Vincent | Cerf, Charles | Cassaing, Sophie | Recher, Christian | Picard, Muriel | Protin, Caroline | Huguet, Françoise | Huynh, Anne | Ruiz, Jean | Riu-Poulenc, Béatrice | Letocart, Philippe | Marchou, Bruno | Verdeil, Xavier | Cavalié, Laurent | Chauvin, Pamela | Iriart, Xavier | Valentin, Alexis | Bouvet, Emmanuelle | Delmas-Marsalet, Béatrice | Jeblaoui, Asma | Kassis-Chikhani, Najiby | Mühlethaler, Konrad | Zimmerli, Stefan | Zalar, Polona | Sánchez-Reus, Ferran | Gurgui, Merce
mBio  2014;5(6):e02309-14.
ABSTRACT
Rapidly fatal cases of invasive fungal infections due to a fungus later identified as Saprochaete clavata were reported in France in May 2012. The objectives of this study were to determine the clonal relatedness of the isolates and to investigate possible sources of contamination. A nationwide alert was launched to collect cases. Molecular identification methods, whole-genome sequencing (WGS), and clone-specific genotyping were used to analyze recent and historical isolates, and a case-case study was performed. Isolates from thirty cases (26 fungemias, 22 associated deaths at day 30) were collected between September 2011 and October 2012. Eighteen cases occurred within 8 weeks (outbreak) in 10 health care facilities, suggesting a common source of contamination, with potential secondary cases. Phylogenetic analysis identified one clade (clade A), which accounted for 16/18 outbreak cases. Results of microbiological investigations of environmental, drug, or food sources were negative. Analysis of exposures pointed to a medical device used for storage and infusion of blood products, but no fungal contamination was detected in the unused devices. Molecular identification of isolates from previous studies demonstrated that S. clavata can be found in dairy products and has already been involved in monocentric outbreaks in hematology wards. The possibility that S. clavata may transmit through contaminated medical devices or can be associated with dairy products as seen in previous European outbreaks is highly relevant for the management of future outbreaks due to this newly recognized pathogen. This report also underlines further the potential of WGS for investigation of outbreaks due to uncommon fungal pathogens.
IMPORTANCE
Several cases of rapidly fatal infections due to the fungus Saprochaete clavata were reported in France within a short period of time in three health care facilities, suggesting a common source of contamination. A nationwide alert collected 30 cases over 1 year, including an outbreak of 18 cases over 8 weeks. Whole-genome sequencing (WGS) was used to analyze recent and historical isolates and to design a clade-specific genotyping method that uncovered a clone associated with the outbreak, thus allowing a case-case study to analyze the risk factors associated with infection by the clone. The possibility that S. clavata may transmit through contaminated medical devices or can be associated with dairy products as seen in previous European outbreaks is highly relevant for the management of future outbreaks due to this newly recognized pathogen.
doi:10.1128/mBio.02309-14
PMCID: PMC4271555  PMID: 25516620
3.  Burden of influenza, healthcare seeking behaviour and hygiene measures during the A(H1N1)2009 pandemic in France: a population based study 
BMC Public Health  2012;12:947.
Background
Influenza surveillance systems do not allow the identification of the true burden of illness caused by influenza in the community because they are restricted to consulting cases. A study was conducted to estimate the incidence and the burden of self-defined influenza, and to describe healthcare seeking behavior for self-defined influenza during the A(H1N1)2009 pandemic in the French population.
Methods
We conducted a random-based retrospective cross-sectional telephone survey between May 2009 and April 2010 among a random sample of the French population.
Results
For the 10 076 people included, 107 episodes of self-defined influenza were reported. The annual incidence of self-defined influenza was estimated at 13 942 cases per 100 000 inhabitants (CI95% 10 947 – 16 961), 62.1% (CI95% 50.5 – 72.5) of cases consulted a physician and 11.3% (CI95% 5.5 - 21.7) used a face mask. Following recommendations, 37.5% (CI95% 35.5 – 39.5) of people in the survey reported washing their hands more often during the pandemic season, and there was a positive association with being vaccinated against A(H1N1)2009 influenza, being a women, being a child (< 15 years) or living in a big city (≥ 100 000 inhabitants).
Conclusions
Self-defined influenza causes a significant burden of illness in the French population and is a frequent cause for consultation. These results allow a more accurate interpretation of influenza surveillance data and an opportunity to adapt future health education messages.
doi:10.1186/1471-2458-12-947
PMCID: PMC3508974  PMID: 23127166
Self-defined influenza; Burden; Epidemiology; Incidence; Surveillance
4.  Field Effectiveness of Pandemic and 2009-2010 Seasonal Vaccines against 2009-2010 A(H1N1) Influenza: Estimations from Surveillance Data in France 
PLoS ONE  2011;6(5):e19621.
Background
In this study, we assess how effective pandemic and trivalent 2009-2010 seasonal vaccines were in preventing influenza-like illness (ILI) during the 2009 A(H1N1) pandemic in France. We also compare vaccine effectiveness against ILI versus laboratory-confirmed pandemic A(H1N1) influenza, and assess the possible bias caused by using non-specific endpoints and observational data.
Methodology and Principal Findings
We estimated vaccine effectiveness by using the following formula: VE  =  (PPV-PCV)/(PPV(1-PCV)) × 100%, where PPV is the proportion vaccinated in the population and PCV the proportion of vaccinated influenza cases. People were considered vaccinated three weeks after receiving a dose of vaccine. ILI and pandemic A(H1N1) laboratory-confirmed cases were obtained from two surveillance networks of general practitioners. During the epidemic, 99.7% of influenza isolates were pandemic A(H1N1). Pandemic and seasonal vaccine uptakes in the population were obtained from the National Health Insurance database and by telephonic surveys, respectively. Effectiveness estimates were adjusted by age and week. The presence of residual biases was explored by calculating vaccine effectiveness after the influenza period. The effectiveness of pandemic vaccines in preventing ILI was 52% (95% confidence interval: 30–69) during the pandemic and 33% (4–55) after. It was 86% (56–98) against confirmed influenza. The effectiveness of seasonal vaccines against ILI was 61% (56–66) during the pandemic and 19% (−10–41) after. It was 60% (41–74) against confirmed influenza.
Conclusions
The effectiveness of pandemic vaccines in preventing confirmed pandemic A(H1N1) influenza on the field was high, consistently with published findings. It was significantly lower against ILI. This is unsurprising since not all ILI cases are caused by influenza. Trivalent 2009-2010 seasonal vaccines had a statistically significant effectiveness in preventing ILI and confirmed pandemic influenza, but were not better in preventing confirmed pandemic influenza than in preventing ILI. This lack of difference might be indicative of selection bias.
doi:10.1371/journal.pone.0019621
PMCID: PMC3091864  PMID: 21573005
5.  Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: a cross-sectional survey 
BMC Public Health  2011;11:30.
Background
Following the emergence of the influenza A(H1N1)2009 virus, the French ministry of health decided to offer free vaccination against pandemic influenza to the entire French population. Groups of people were defined and prioritised for vaccination.
Methods
We took a random sample of the population of mainland France and conducted a retrospective cross-sectional telephone survey to estimate vaccination coverage against seasonal and pandemic influenza and to identify determinants of these vaccinations.
Results
10,091 people were included in the survey. Overall seasonal influenza vaccination coverage (IVC) remained stable in the population from the 2008-2009 season to the 2009-2010 season reaching 20.6% and 20.8% respectively. Overall pandemic IVC in the French population is estimated to be 11.1% (CI95%: 9.8 - 12.4). The highest pandemic IVC was observed in the 0-4 years age group. For individuals with health conditions associated with higher risk of influenza, pandemic IVC was estimated to be 12.2% (CI95%: 9.8 - 15.1). The main determinants associated with pandemic influenza vaccine uptake were: living in a household with a child < 5 years ORadj: 2.0 (CI95%: 1.3 - 3.1) or with two children < 5 years or more, ORadj: 2.7 (CI95%: 1.4 - 5.1), living in a household where the head of the family is university graduate (>2 years), ORadj: 2.5 (CI95%: 1.5 - 4.1), or has a higher professional and managerial occupation, ORadj: 3.0 (CI95%: 1.5 - 5.5) and being vaccinated against seasonal influenza, ORadj: 7.1 (CI95%: 5.1 - 10.0). Being an individual with higher risk for influenza was not a determinant for pandemic influenza vaccine uptake. These determinants are not the same as those for seasonal influenza vaccination.
Conclusions
Overall A(H1N1)2009 influenza vaccine uptake remained low, particularly among individuals with higher risk for influenza and was lower than that observed for seasonal influenza. The reasons behind people's reluctance to be vaccinated need to be investigated further.
doi:10.1186/1471-2458-11-30
PMCID: PMC3025842  PMID: 21226919
6.  Influenza vaccination coverage of healthcare workers and residents and their determinants in nursing homes for elderly people in France: a cross-sectional survey 
BMC Public Health  2010;10:159.
Background
Nursing home residents bear a substantial burden of influenza morbidity and mortality. Vaccination of residents and healthcare workers (HCWs) is the main strategy for prevention. Despite recommendations, influenza vaccination coverage among HCWs remains generally low.
Methods
During the 2007-2008 influenza season, we conducted a nationwide survey to estimate influenza vaccination coverage of HCWs and residents in nursing homes for elderly people in France and to identify determinants of vaccination rates. Multivariate analysis were performed with a negative binomial regression.
Results
Influenza vaccination coverage rates were 33.6% (95% CI: 31.9-35.4) for HCWs and 91% (95% CI: 90-92) for residents. Influenza vaccination uptake of HCWs varied by occupational category. Higher vaccination coverage was found in private elderly care residences, when free vaccination was offered (RR: 1.89, 1.35-2.64), in small nursing homes (RR: 1.54, 1.31-1.81) and when training sessions and staff meetings on influenza were organized (RR: 1.20, 1.11-1.29). The analysis by occupational category showed that some determinants were shared by all categories of professionals (type of nursing homes, organization of training and staff meetings on influenza). Higher influenza vaccination coverage was found when free vaccination was offered to recreational, cleaning, administrative staff, nurses and nurse assistants, but not for physicians.
Conclusions
This nationwide study assessed for the first time the rate of influenza vaccination among residents and HCWs in nursing homes for elderly in France. Better communication on the current recommendations regarding influenza vaccination is needed to increase compliance of HCWs. Vaccination programmes should include free vaccination and education campaigns targeting in priority nurses and nurse assistants.
doi:10.1186/1471-2458-10-159
PMCID: PMC2850345  PMID: 20338028

Results 1-6 (6)