Absolute participation in each arm according to the variable (age group, department, French DEPrivation index, beneficiary of the complementary health insurance, previous screening, invited to complete questionnaire).

Study population before and after the sensitivity analysis.

BACKGROUND:Despite organised screening efforts since 2018 targeting under-screened women, cervical cancer (CC) screening coverage remains moderate (60 %) in France. The target age for HPV-based screening is women aged 30-65. Vaginal self-sampling (VSS) has recently been introduced for women who have not been screened. This study assesses women's perceptions and preferences toward HPV self-sampling among women enrolled in the CapU4 trial. METHODS:CapU4 is a randomised controlled trial with two experimental arms (mailing either a urine self-sampling (USS) or VSS kit) and a control arm (mailing of a conventional invitation letter). The trial invited 15,000 women aged 30-65, who had no screening test recorded since more than four years and who did not respond to an invitation letter within 12 months before. Half of the women in each arm were randomly selected to receive a supplementary questionnaire (sent in March 2023, with responses collected until August 2023). RESULTS:In total, 682 completed questionnaires were analysed (9.1 % response rate). Most women found self-sampling instructions clear (VSS 87.4 %, USS 90.7 %) and procedures easy (VSS 85.9 %, USS 90.3 %). About 23.5 % of VSS users and 4.9 % of USS users found the process unpleasant. Around 80 % of participants in both SS arms preferred taking a specimen at home rather than going to a health care professional for cervical screening. They also indicated a preference for using self-sampling kit to collect a sample for their next CC screening instead of visiting a health care professional (VSS 82.6 %, USS 89.1 %). CONCLUSION:Self-sampling appears to be a well-received alternative in women not attending routine CC screening programme.

BACKGROUND:Timely administration of the hepatitis B virus (HBV) birth dose vaccine, along with identifying high-risk pregnant individuals for antiviral prophylaxis, is essential for the global elimination of vertical transmission of HBV. However, in resource-limited settings, access to HBV DNA testing is scarce, and accurate rapid tests for HBeAg are lacking. We aimed to assess the diagnostic performance of a newly developed hepatitis B core-related antigen (HBcrAg) rapid diagnostic test (RDT) to identify women who are HBsAg-positive and eligible for antiviral prophylaxis. METHODS:In this multicountry diagnostic accuracy study, we retrospectively validated the HBcrAg-RDT using stored plasma from pregnant women who were HBsAg-positive in cohort studies from Cambodia and Cameroon and prospectively using finger-prick capillary blood from postpartum mothers at rural health centres in Burkina Faso. We estimated the sensitivity and specificity of the HBcrAg-RDT for diagnosing high HBV DNA concentrations (≥200 000 IU/mL) using real-time PCR (rtPCR) as the reference. We compared the diagnostic performance of the HBcrAg-RDT with that of conventional HBeAg assays based on the area under the receiver operating characteristic curve (AUROC). FINDINGS:In total, plasma samples were available for 1964 participants: 1194 stored plasma samples available for analysis from the Cambodian cohort, 501 stored samples from the Cameroonian cohort, and 269 prospectively collected samples from women in the Burkina Faso cohort. In the pooled population, the mean age was 28·1 years (SD 6·0), and 382 (20·0%) were HBeAg positive. The HBcrAg-RDT showed an overall sensitivity of 93·1% (95% CI 90·5-95·2) and specificity of 94·3% (93·0-95·4). Sensitivity and specificity were 93·4% (90·7-95·5) and 94·4% (92·9-95·6) in the retrospective laboratory-based analyses of samples from Cambodia and Cameroon, and 89·7% (75·8-97·1) and 93·9% (90·0-96·6) in the prospective real-world analysis of samples of HBsAg-positive women from Burkina Faso. The AUROC for HBcrAg-RDT (0·937 [95% CI 0·924-0·950]) in distinguishing high versus low HBV DNA concentrations at the 200 000 IU/mL threshold in the pooled data set was significantly higher than that of HBeAg rapid tests (0·822 [0·798-0·845]; p<0·0001) and similar to laboratory-based HBeAg immunoassays (ELISA and chemiluminescence assay; 0·926 [0·897-0·955]; p=0·72). In Burkina Faso, the median turnaround time for HBV DNA testing was 46 days (IQR 31-72), whereas HBcrAg-RDT provided same-day results for all participants. INTERPRETATION:HBcrAg-RDT might offer a practical solution for integrating the prevention of vertical transmission of HBV into decentralised antenatal care in resource-limited settings, enabling timely identification and management of pregnant individuals who are at high risk of transmission. FUNDING:Agence Nationale de Recherches sur le Sida et les Hépatites Virales, Total Foundation, Gilead Sciences, and Japan Society for the Promotion of Science. TRANSLATION:For the French translation of the abstract see Supplementary Materials section.

Participation differences and relative participation considering women who did not receive the invitation were considered as non-responders (sensitivity analysis).

BACKGROUND:Human papillomavirus testing on vaginal self-samples (VSS) has recently been offered in France as an option for women aged 30 to 65 years who are not regularly screened for cervical cancer. Human papillomavirus testing can also be performed on first-void urine. METHODS:The CapU4 study is a three-arm randomized controlled trial enrolling 14,997 women aged 30 to 65 years who had no screening test recorded for more than 4 years and who did not respond to an invitation letter 12 months prior. Women were allocated to two experimental arms [mailing of a VSS or a urine self-sampling (USS) kit] or to a control arm (invitation to visit a physician to collect a cervical specimen). RESULTS:A total of 13,061 women were included. The intention-to-treat analysis demonstrated that the participation rate increased in the self-sampling arms (USS: 23.6%; VSS: 23.5%) compared with the control arm (12.9%). The per-protocol analysis did not show a favorable effect (USS: 11.1%; VSS: 12.6%), particularly for USS. CONCLUSIONS:Invitations including VSS or USS kits increased participation in cervical cancer screening by approximately 11%. Half of the responding women in the self-sampling arms visited a physician to take a cervical specimen. IMPACT:There is evidence that sending VSS kits can increase attendance at cervical cancer screening. However, no data exist suggesting that sending urine collection kits may also be effective in triggering participation compared with conventional invitation letters. The results of the CapU4 trial may generate innovative tools that could help optimize attendance at cervical cancer screening.

Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.

Cervical cancer (CC) was diagnosed in 3159 women in France in 2023, and 1117 died from it. Organized screening for cervical cancer is potentially very effective for participating women. However, reaching under-screened populations remains a major challenge. The present qualitative study explored women’s opinions on what discourages or encourages them to participate in CC screening and assessed the acceptability of two experimental strategies (urinary or vaginal self-sampling kits) to increase the screening coverage in three rural French administrative departments with low medical density and/or low screening participation rates. Forty-eight semi-structured interviews and four focus groups were conducted by a team of psychologists. Results showed that the participants accepted at-home self-sampling to reach non-participating women in medically underserved areas. However, they suggested that the type of kit sent should be adapted to the patient’s profile (embarrassment from earlier exams, cultural aspects, fear of invasiveness, etc.), and that kits should be simple to use (in understandable language taking sociocultural aspects into account). Women wished to be assured that testing on self-samples is accurate and needed information about further actions in case of a positive result.

Self-sampling may improve participation in cervical cancer secondary prevention programs by women who do not respond or respond irregularly when invited to contact a health professional for the collection of a cervical specimen. It could also help resolve access problems in areas with a low physician density. The present qualitative study examined barriers to screening, effective screening strategies, and the advantages and disadvantages of sending women urine or vaginal self-sampling kits in two medically underserved administrative departments in France (Mayenne and Sarthe) showing low cervical screening coverage. As part of the CapU4 randomized trial, a team of psychologists investigated the attitudes and experiences of 59 healthcare professionals (gynecologists, general practitioners, and midwives) through semi-structured interviews. Results indicated that health professionals believe that self-sampling may address the issues of low physician density and underscreening by removing logistical, organizational, financial, and psychological obstacles. They confirmed trust in the use of vaginal self-sampling, with urine self-sampling as an alternative solution (e.g., for women with vaginismus). The health professionals also identified several limitations of the self-sampling kit that will need to be addressed in future screening campaigns (incomplete kit, complex instructions, poor anatomical knowledge, and obesity).

Background In sub-Saharan Africa, administration of hepatitis B virus (HBV) birth-dose vaccines remains suboptimal. Evidence is scarce on whether African countries should focus on increasing vaccine coverage or developing strategies incorporating additional measures, such as peripartum antiviral prophylaxis to pregnant women at high risk. To better inform decision makers, we estimated the residual risk of mother-to-child transmission despite HBV birth- dose vaccine in Cameroon. Methods We did a single-centre, longitudinal observational study. Pregnant women were systematically screened for HBV surface antigen (HBsAg) at Tokombere District Hospital (Tokombere district, Cameroon). Children born to HBsAg-positive mothers in 2009-16 who received the HBV birth-dose vaccine and three subsequent doses of pentavalent vaccine at 6, 10, and 14 weeks were followed up prospectively in 2015-17. In children, capillary blood was obtained for HBsAg rapid test and dried blood spots to quantify HBV DNA concentrations. Venous blood was also collected from HBsAg-positive children. Mother-to-child transmission was confirmed by whole-genome sequencing. Findings Between Jan 31, 2009, and Dec 31, 2016, 22 243 (66.8%) of 33 309 pregnant women accepted antenatal HBV screening, of whom 3901 (17.5%) were HBsAg positive. 2004 (51.4%) of 3901 children who were born to HBsAg-positive mothers received the HBV birth-dose vaccine, of whom 1800 (89.8%) also completed the three-dose pentavalent vaccine. In total, the current analysis included 607 children who had a follow-up serosurvey. The prevalence of HBsAg was 5.6% in children who received the birth-dose vaccine in less than 24 h, 7.0% in those who received it 24-47 h after birth, and 16.7% in those who received it 48-96 h after birth (p trend=0.083). 35 (89.7%) of 39 infected children were born to mothers positive for HBV e antigen with high HBV DNA of 5.3 log 10 IU/mL or more. Whole-genome sequencing of HBV in infected mother-child pairs confirmed high identity proportions of 99.97-100%. Interpretation We documented a substantial risk of mother-to-child transmission despite timely administration of the HBV birth-dose vaccine within 24 h after birth. To reach WHO's elimination targets, peripartum antiviral prophylaxis might be required in parts of Africa, in addition to increasing coverage of the HBV birth-dose vaccine. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.

Despite the fact that hand hygiene is considered an important issue in preventing SARS-CoV-2 transmission, very few studies have documented the detection or survival of the SARS-CoV-2 on human skin [[1]Harbourt D.E. Haddow A.D. Piper A.E. Bloomfield H. Kearney B.J. Fetterer D. et al.Modeling the stability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on skin, currency, and clothing.PLoS Negl Trop Dis. 2020; 14e0008831https://doi.org/10.1371/journal.pntd.0008831Crossref PubMed Scopus (61) Google Scholar,[2]Hirose R. Ikegaya H. Naito Y. Watanabe N. Yoshida T. Bandou R. et al.Survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus on human skin: importance of hand hygiene in coronavirus disease 2019 (COVID-19).Clin Infect Dis. 2021; 73: e4329-e4335https://doi.org/10.1093/cid/ciaa1517Crossref PubMed Scopus (63) Google Scholar]. None, to our knowledge, has been conducted under real-life conditions. We conducted an observational study from May to October 2021 (mainly variant delta spread) in a university hospital to assess the detection of SARS-CoV-2 RNA on healthcare workers' (HCW's) hands involved in COVID-19 patients' care. We included any type of care delivered to hospitalized isolated COVID-19 cases (i.e. patients within 10 days of symptom onset, or 20 days if immunocompromised or on the intensive care unit (ICU)). Data relating to the care provided were collected prospectively: patient characteristics, time of sampling, HCW job role and type of care provided by the HCW and practices with their hands. Early and late COVID-19 were defined as <7 days and ≥7 days after symptom onset. A single sterile pre-moistened swab with universal transport medium (regular floq swab, UTM® 346C; Copan, Brescia, Italy) was used for each sampling of HCWs' hands; sampling was across the entire surface area of both hands (palm, fingers, back of the hand, interdigital spaces). Each HCW was sampled on three occasions: (i) before care (and any glove wearing); (ii) immediately after care before any hand hygiene, but after glove removal (if used); and (iii) immediately after hand hygiene using a hydro-alcoholic hand rub. Samples were analysed using a reverse transcription–quantitative polymerase chain reaction assay (laboratory developed test) running on the Panther Fusion® module on the Panther® system (Hologic®; San Diego, CA, USA) using primers (nCoV_IP2 and nCoV_IP4) targeting two regions on the RNA-dependent RNA polymerase (RdRp) gene (National Reference Center of respiratory viruses; Institut Pasteur, Paris, France). A sample was considered positive if one or both sequences on the RdRp gene were detected. Cycle threshold (CT) values, i.e. number of cycles of quantitative PCR, estimate viral load. The study was approved by the ethics committee of the University Hospital of Angers (agreement 2021-110). One hundred and ninety-four samples were collected, respectively 62, 66, and 66 samples before care, after care and after hand hygiene relating to 54 patients (more than one contact was observed for seven patients). Table I summarizes the characteristics of patients and the care episodes. Thirty and 36 contacts were with early (median: 3 (range: 1–6) days post-symptom onset) and late (median: 11 (range: 7–20) days post-symptom onset) COVID-19, respectively.Table ICharacteristics of patients and their careCharacteristics and care groupNo.%MedianIQRHealthcare worker category Medical doctor00 Resident/medical student1116.7 Nurse3248.5 Nurse assistant2030.3 Physiotherapist00 Occupational therapist00 OthersaTwo midwives and one radiology technician.34.5Type of care No direct contact with the patient or biological matters913.6 Direct contact with the patient, short duration (<5 min), no contact with biological matters2537.9 Direct contact with patient, long duration (>5 min) and/or contact with biological mattersbIncluding 13 care involving contact with stools or sputum.3248.5Care with gloves5177.3Patient age (years)65.751.9–74.5Delay between symptom onset and sampling (days)7.53–11.8Hospitalized in ICU2240.7Immunocompromised814.8Oxygen therapy None2037.0 <6 L1425.9 >6 L611.1 Intubated1425.9Katz score3.50–9Charlson score31–6Coughing (40 patients assessed)1230.0Wearing mask during care (39 patients assessed)615.4Treatment Dexamethasone3463.0 Tocilizumab1324.1 Monoclonal antibodies11.9 Convalescent plasma00 Others00Vaccination status (51 available) 1 dose815.7 2 doses1529.1 3 doses12.0 Unvaccinated2752.9IQR, interquartile range; ICU, intensive care unit.a Two midwives and one radiology technician.b Including 13 care involving contact with stools or sputum. Open table in a new tab IQR, interquartile range; ICU, intensive care unit. Two samples were positive (CT >37 for both), both after care of early COVID-19 patients (6.7% of after care of early patients' samples). The first positive sample was from a nurse after several interactions with an ICU patient's environment (no direct patient contact) with no gloves worn. The patient was intubated, non-immunocompromised, and unvaccinated. The patient had been symptomatic for two days; Charlson score was 6 and treatment was with dexamethasone. The second positive sample was from a nursing assistant after bathing a patient on a general ward. The patient was not immunocompromised, had a three-day history of symptoms and had received one dose of vaccine. Katz and Charlson scores were 5 and 10, respectively; the patient was receiving neither specific treatment for COVID-19, nor oxygen; he was not coughing, but not wearing a mask. To our knowledge, our study is the first to characterize SARS-CoV-2 RNA detection on HCW hands in 'real life' conditions. SARS-CoV-2 has been shown to survive for several hours on skin [[2]Hirose R. Ikegaya H. Naito Y. Watanabe N. Yoshida T. Bandou R. et al.Survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus on human skin: importance of hand hygiene in coronavirus disease 2019 (COVID-19).Clin Infect Dis. 2021; 73: e4329-e4335https://doi.org/10.1093/cid/ciaa1517Crossref PubMed Scopus (63) Google Scholar]. HCW hand contamination may be associated with viral load, type of care, duration of care, exposure to droplets and environmental conditions (humidity, temperature, etc.). However, our study was not powered to assess these variables. It has been suggested that SARS-CoV-2 may be present on patients' skin, from where it might be transferred to HCWs' hands [[3]Redmond S.N. Li D.F. Haq M.F. Jones L.D. Nguyen A.M. Tiktin M. et al.Frequent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on hands and skin of patients with coronavirus disease 2019 (COVID-19).Infect Control Hosp Epidemiol. 2021; : 1-2https://doi.org/10.1017/ice.2021.403Crossref Scopus (2) Google Scholar]. Our study has some limitations. We did not perform viral cultures and cannot exclude the possibility that the SARS-CoV-2 RNA that we detected represents non-viable virus. The few studies that have looked for viable virus on environmental samples have mostly reported negative results [4Abbas M. Robalo Nunes T. Martischang R. Zingg W. Iten A. Pittet D. et al.Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers.Antimicrob Resist Infect Control. 2021; 10: 7https://doi.org/10.1186/s13756-020-00875-7Crossref PubMed Scopus (111) Google Scholar, 5Rickman H.M. Rampling T. Shaw K. Martinez-Garcia G. Hail L. Coen P. et al.Nosocomial transmission of coronavirus disease 2019: a retrospective study of 66 hospital-acquired cases in a London teaching hospital.Clin Infect Dis. 2021; 72: 690-693https://doi.org/10.1093/cid/ciaa816Crossref PubMed Scopus (128) Google Scholar, 6Zhou J. Otter J.A. Price J.R. Cimpeanu C. Meno Garcia D. Kinross J. et al.Investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surface and air contamination in an acute healthcare setting during the peak of the coronavirus disease 2019 (COVID-19) pandemic in London.Clin Infect Dis. 2021; 73 (e1870–7)https://doi.org/10.1093/cid/ciaa905Crossref Scopus (114) Google Scholar]. The high CT-values that we found suggested low viral loads or non-viable virus. We did not sample the HCWs to exclude them asymptomatically shedding virus; however, neither HCW's 'before care' sample was positive. Finally, an alternative sampling method, e.g. a 'glove-juice' sampling method, might have been more appropriate [[7]Casanova L.M. Weaver S.R. Evaluation of eluents for the recovery of an enveloped virus from hands by whole-hand sampling.J Appl Microbiol. 2015; 118: 1210-1216https://doi.org/10.1111/jam.12777Crossref PubMed Scopus (31) Google Scholar]. Nevertheless, we showed that, although infrequent, SARS-CoV-2 RNA could be found on HCWs' hands after delivering direct and indirect care to early COVID-19 patients. Further studies are needed to assess the significance of SARS-CoV-2 hand carriage by HCWs. The authors thank Virology laboratory team and Infection Control and Prevention Unit team. None declared. None.

The A1762T/G1764A double mutant in the basal core promoter (BCP) region of the hepatitis B virus (HBV) is associated with severe hepatic lesions while the G1899A mutation with the double mutant is associated with a significant reduction in the risk of severe fibrosis. This study aims to measure a number of markers in the serum of patients with chronic HBV infection and to assess relationships between these markers and BCP/precore mutants with consideration of the stage of fibrosis. The serum levels of resistin, TGF-β1, MMP-1, TIMP-1, collagen IA1 and PDGF-BB, which are markers that are known to be involved in the process of hepatic fibrosis, were assayed. The serum levels of PDGF-BB and TIMP-1, and the mutation profile were independently associated with advanced fibrosis. A higher level of TIMP-1 was associated with advanced fibrosis regardless of the mutation status, and a higher level of PDGF-BB was associated with nonsevere fibrosis in patients infected with viruses harboring the A1762T/G1764A or A1762T/G1764A/G1899A mutations. Our results suggest an impact of the A1762T/G1764A mutant on the biological pathway related to TGF-β1 and PDGF-BB. In vitro studies are needed to understand the impact of these mutants on the serum secretion of markers involved in fibrosis severity.

To assist in the clinical management of patients and to support infection control, we tested the use of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) point-of-care antigen test (AgPOC) for unplanned hospitalization, coupled with a nucleic acid amplification test (NAAT) using specimens collected at the same time upon arrival. The aim of this study was to assess the performance of the AgPOC in this specific use compared to NAAT for SARS-CoV-2 diagnosis, in the context of the low prevalence of infection. For 5 months (between two peaks in France of the SARS-CoV-2 pandemic), all patients admitted who undertook the AgPOC/NAAT paired tests were included in the study. AgPOC performances were determined considering the clinical status and the delay of symptoms onset. NAAT and AgPOC results were available for 4425 subjects. AgPOC results showed a homogeneous specificity (>97%) but a low sensitivity at 45.8%. Considering the national guidelines, sensitivity dropped to 32.5% in cases of symptomatic patients with symptoms older than 5 days or more. This study shows the poor performance of AgPOC for entry screening of patients in hospitals. AgPOC may represent a useful tool in the hospital setting only if the use is restricted to patients with consistent symptoms less than 4 days old.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) highlights the importance of rapid diagnostic testing to identify individuals with SARS-CoV-2 infections and to limit the spread of the virus. Many molecular assays have become commercially available to cope with this surging demand for timely diagnosis of COVID-19 cases, but identifying individuals requires accurate diagnostic tools. We compared the performance of three molecular SARS-CoV-2 assays: Aptima (TM) SARS-CoV-2 assay running on the Panther system (Hologic), an in-house assay (Laboratory Developed Test, LDT) running on the Fusion module of the Panther Fusion system (LDT-Fusion; Hologic), and the R-GENE (R) SARS-CoV-2 assay (bioMerieux). In addition, we also evaluated the turnaround time. This parameter is crucial to managing the SARS-CoV-2 diagnosis and represents a key point in the quality management at the laboratory. Aptima (TM) and LDT-Fusion assays exhibited an excellent positive percent agreement (PPA) (100.0%), while the R-GENE (R) assay showed a slightly decreased PPA (98.2%). The Hologic assays have a higher throughput with less hands-on time than the R-GENE (R) assays (24-25 vs. 71 min). Both Hologic assays are used on a fully automated random-access testing system with on-demand testing capabilities that avoid run series, unlike the R-GENE (R) assay. Automated random-access testing systems should be preferred during periods of high SARS-CoV-2 prevalence.

Objectives: The cervical cancer screening coverage remains moderate (60%) in France. The aim of the study is to evaluate the efficacy of two experimental invitation strategies (offer of urine or vaginal self-sampling kits) to reach under-screened populations and compare them with the current invitation strategy in rural departments (low medical density and low participation rate) in France.Methods: The study is a randomised controlled trial with three arms: a control arm (conventional invitation letter) and two experimental arms (mailing of a urine or vaginal self-sampling kit). The target population includes women aged 30–65 years, who had no screening test recorded since more than 4 years and who did not respond to an invitation letter within 12 months before. The primary outcome measure is the participation rate in each arm. A team of psychologists will also investigate attitudes and experiences by semi-structured/focus-group interviews with voluntary CapU4 participants and with health professionals.Result and conclusion: CapU4 will identify effective strategies to reach women not responding to current screening invitations and will generate information about acceptance of self-sampling among women and health professionals.

Currently, there is a lack of systems for studying the role of hepatitis B viral proteins, such as HBeAg and HBcAg, on liver injury. It is necessary to develop an original tool in order to clarify the role of these viral proteins in hepatic stellate cell activation, and to understand the molecular mechanisms of liver injury. HepaRG are the most reliable hepatocyte-like cells for studying liver functions or disorders. In this paper, we demonstrate that the transduction of differentiated HepaRG (dHepaRG) cells can be performed successfully using lentiviral particles. The production of a functional Green Fluorescent Protein (GFP) assessed by Fluorescence Activated Cell Sorting and fluorescence microscopy is up to 16% of GFP positive cells using a multiplicity of infection (MOI) of 2.4. We demonstrate that this technology can allow the stable expression of GFP during the long lifecycle of the cell (up to four weeks after the cell’s passage). With this innovative tool, we aim to express viral proteins such as HBeAg or HBcAg in dHepaRG cells. The preliminary results of this work shows that HBeAg can be efficiently produced in dHepaRG cells and that increased MOI allows a better production of this protein. Our future objective will be to study the role of HBc and HBe proteins on the induction of hepatic fibrosis.

Objectives: Hepatitis B and D infections are highly endemic in Mauritania, with prevalences ranging from 10 to 20%. With the present prospective transversal pilot study, we aimed to evaluate the prevalences of HBV, HCV, and HDV infections in healthcare workers (HCWs), and offer treatment or vaccination as required. Methods: At inclusion, each HCW was screened for anti-HBc Ab (followed by HBsAg assay when positive). Additional biological analyses were performed for HBsAg + cases. Depending on the results, HBV vaccination or anti-viral treatment was offered. Results: A total of 3,857 HCWs were included, of whom 1,363 tested negative for anti-HBc Ab and received full vaccination. Of the 2,494 HCWs who were positive for anti-HBc Ab, 1,246 were positive for anti-HBs Ab and 418 were positive for HBsAg. Three HCWs were positive for HBeAg; 66 and 18 had HBV DNA levels respectively > 2,000 and > 20,000 IU/mL; and 48 were positive for anti-HDV Ab among whom 10 were positive for HDV RNA. HCV prevalence was 0.5%. Only seven HCWs fulfilled the criteria for treatment and five of them were treated. Conclusion: Few HCWs in Mauritania are immunised against HBV. The prevalences of anti-HBc Ab and HBsAg observed in this work were similar to those observed in our earlier works, whereas prevalence of active HDV infection was less high. HBV and HDV infections are a serious health concern in Mauritania. New recommendations developed in accordance with WHO guidelines should include mandatory HBV screening and immunisation for HCWs. (C) 2021 Elsevier Ltd. All rights reserved.

SARS-CoV-2 coronavirus infection induces heterogeneous symptoms, ranging from asymptomatic to lethal forms. Severe forms usually occur in the elderly and/or individuals with comorbidities. Children generally remain asymptomatic to primary infection, suggesting that they may have an effective local innate immune response. IFN-I and -III have non-redundant protective roles against SARS-CoV-2, although sometimes damaging the host. The expression and role of anti-viral peptides during SARS-CoV-2 infection have thus far been little studied. We aimed to identify the innate immune molecules present at the SARS-CoV-2 entry point. We analyzed the mRNA levels of type I (IFN-α and -β) and type III (IFN-λ1-3) interferons and selected antiviral peptides ( i.e. , β-defensins 1-3, α-defensins [HNP1-3, HD5] pentraxin-3, surfactant protein D, the cathelicidin LL-37 and interleukin-26) in nasopharyngeal swabs from 226 individuals of various ages, either infected with SARS-CoV-2 (symptomatic or asymptomatic) or negative for the virus. We observed that infection induced selective upregulation of IFN-λ1 expression in pediatric subjects (≤15 years), whereas IFN-α, IFN-β, IFN-λ2/λ3, and β-defensin 1-3 expression was unaffected. Conversely, infection triggered upregulation of IFN-α, IFN-β, IFN-λ2/λ3, and β-defensin 1-3 mRNA expression in adults (15-65 years) and the elderly (≥ 65 years), but without modulation of IFN-λ1. The expression of these innate molecules was not associated with gender or symptoms. Expression of the interferon-stimulated genes IFITM1 and IFITM3 was upregulated in SARS-CoV-2-positive subjects and reached similar levels in the three age groups. Finally, age-related differences in nasopharyngeal innate immunity were also observed in SARS-CoV-2-negative subjects. This study shows that the expression patterns of IFN-I/-III and certain anti-viral molecules in the nasopharyngeal mucosa of SARS-CoV-2-infected subjects differ with age and suggests that susceptibility to SARS-CoV-2 may be related to intrinsic differences in the nature of mucosal anti-viral innate immunity.