Objective. - Preventive measures were implemented in the French armed forces to limit the measles outbreak that occurred in 2010 and 2011. This study aimed to obtain feedback concerning the management of this outbreak by the French military general practitioners.Method. - A cross-sectional study was conducted among the general practitioners (GPs) in military units located in metropolitan France. The 60 military units that reported at least one measles case in 2011 were included. Data were collected using self-administered questionnaires.Results. - The acceptance of preventive measures against measles was good (measures "totally justified'' for 77.8%) and most of the military GPs considered that the outbreak had no significant impact on their activities. The management of measles cases was perceived as not very problematic but difficulties were encountered in the identification of contacts around cases (48.1% of respondents) and in the identification of vaccine recipients among these contacts (more than 80% of respondents reporting difficulties in the collection of measles and vaccination histories). The organization of vaccination around cases was also perceived as difficult.Conclusions. - Preventive measures around measles cases were well accepted by the military GPs, which could reflect their preparedness in the face of the outbreak. However, vaccination did not seem to be well understood or accepted by military patients, underlining the essential role of military GPs in patient information. Difficulties in the collection of vaccination and measles histories among contacts could be overcome by an early transcription of individual medical records in the military medical files of newly enlisted personnel. A more generalized use of oral fluid testing devices, which can be shipped at ambient temperature, would simplify diagnosis in the armed forces. (C) 2014 Elsevier Masson SAS. All rights reserved.

We were interested to read the article by Lee and Wong describing the spatio-temporal spread of the influenza A(H1N1)pdm09 outbreak in Hong Kong using a geographical information system. 1 Lee S.S. Wong N.S. The clustering and transmission dynamics of pandemic influenza A(H1N1) 2009 cases in Hong Kong. J Infect. 2011; 63: 274-280 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar We used a different approach to model the extension of the outbreak in the French armed forces. The effective reproductive number R (average number of secondary infections that arise from a typical primary case) is a mathematical tool enabling the evaluation of the spread of an outbreak prior to the implementation of control measures. An R-value >1 reflects the fact that each case is potentially able to infect more than one new person, which is likely to lead to the extension of the outbreak. Conversely, an R < 1 reflects the fact that each case infects less than one new person, which reflects the decline of the outbreak. For A(H1N1)pdm09 influenza, the R-value was estimated to be between 2.2 and 3.1 by the preliminary Mexican studies conducted from March to April 2009, at the onset of the pandemic. 2 Boëlle P.Y. Bernillon P. Desenclos J.C. A preliminary estimation of the reproduction ratio for new influenza A(H1N1) from the outbreak in Mexico, March–April 2009. Euro Surveill. 2009; 14 (Available online:): pii=19205http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19205 Google Scholar The aim of this work was to estimate the reproductive number R for A(H1N1)pdm09 influenza in the French armed forces.

French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to describe vaccine adverse events (VAE) reported from 2002 to 2010 in armed forces. VAE are routinely surveyed by the military Centre for epidemiology and public health. For each case, military practitioners fill a notification form, providing patient characteristics, clinical information and vaccines administered. For this study, VAE following influenza A(H1N1)pdm09 vaccination were excluded. Among the 473 cases retained, 442 (93%) corresponded to non-severe VAE,including local, regional and systemic events, while 31 corresponded to severe VAE, with two leading to significant disability. The global VAE reporting rate (RR) was 14.0 per 100,000 injections. While stationary from 2002 to 2008, the RR increased from 2009. The most important observations were a marked increase of VAE attributed to Bacillus Calmette-Guérin (BCG) vaccine from 2005 to 2008, a high RR observed with the inactivated diphtheria-tetanus (toxoids)-poliovirus vaccine combined with acellular pertussis vaccine (dTap-IPV) from 2008 and an increase in RR for seasonal influenza vaccine VAE in 2009. Our RR for severe VAE (1.1 VAEper 100,000) appears comparable with rates observed among United States civilians and military personnel. The increase observed from 2009 could be partly explained by the influenza A(H1N1)pdm09 pandemic which increased practitioner awareness towards VAE. In conclusion, the tolerance of the vaccines used in French armed forces appears acceptable.

Objectives: In September 2009, an increase in seasonal influenza vaccine adverse events (VAE), compared with reports for previous years, was detected among the French armed forces in the setting of an extended immunization campaign. This work presents the results of this investigation.Study design: VAE were surveyed among all French military personnel from 2008 to 2009 by Epidemiological Departments of the French Military Health Service. For each case, a notification form was completed, providing patient and clinical information.Methods: Case definitions were derived from the French drug vigilance guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAE to the number of vaccine doses injected.Results: Forty-seven seasonal influenza VAE were reported in continental France: 18 in 2008 and 29 in 2009. The annual reporting rate was higher in 2009 (31.6 vs 16.6 VAE per 100,000 injections, respectively). The highest monthly incidence was observed in September 2009 (60.8 events per 100,000 injections). Two other peaks were observed in February 2008 and March 2009. The incidence in September 2009 was not significantly different from the incidences in February 2008 and March 2009. It was observed that incidence peaks occurred during influenza epidemic periods. One serious neurological VAE was observed.Conclusions: The increase in seasonal influenza VAE in late 2009 mainly involved non-serious events, and could reflect stimulated reporting in the context of the A(H1N1) pdm09 pandemic. VAE reporting rates were highest during influenza epidemic periods, which could be explained by VAE being wrongly attributed to the vaccine when symptoms could reflect coincident background cases of viral infection. (C) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Introduction : les objectifs de ce travail étaient de présenter une synthèse de la surveillance des Toxi-infections alimentaires collectives dans les armées entre 1999 et 2009 et de décrire les caractéristiques épidémiologiques de ces épisodes. Matériels et méthodes : les TIAC sont déclarées à la surveillance épidémiologique des armées, qui concerne tout le personnel militaire en activité. Les données des fiches spécifiques de déclaration et des rapports d'investigation ont été utilisées afin de décrire les caractéristiques épidémiologiques des TIAC survenues durant la période d'étude. Résultats : parmi les 180 TIAC déclarées, 48,3 % sont survenues en dehors de métropole. Le taux d'attaque moyen était de 38,9 %. Les symptômes digestifs étaient au premier plan. Les analyses biologiques chez les cas étaient positives dans 29,4 % des TIAC. Les germes les plus fréquemment rencontrés chez les cas étaient les shigelles (15,4 %). Les analyses alimentaires étaient positives dans 18,9 % des foyers, retrouvant surtout Clostridium perfringens (15,7 %). Seules sept TIAC étaient documentées par des analyses concordantes chez les cas et dans les aliments. Discussion : l'impact des TIAC sur la capacité opérationnelle des militaires peut être majeur, surtout hors de métropole. L'investigation de tels phénomènes est donc indispensable mais demeure difficile compte-tenu de nombreux facteurs organisationnels et opérationnels. L'exhaustivité de la déclaration de TIAC dans les armées reste à améliorer, ce qui passe par une amélioration de la standardisation des procédures d’investigation et de déclaration déjà existantes.

Du fait de leur profession, les militaires sont particulièrement concernés par la problématique des blessures par arme à feu. Les données sont issues de la surveillance épidémiologique des blessures par arme à feu. Les critères de déclaration étaient : « traumatismes (pénétrants ou non) liés à l’utilisation d’une arme à feu, d’engins explosifs ou pyrotechniques, de munitions, militaires ou civiles, à l’exclusion des traumatismes sonores aigus et des conduites auto-agressives ». Entre 2004 et 2008, le taux d’incidence des blessures par arme à feu était de 21,0 p 100 000 personnes-années. Ces blessures sont survenues majoritairement dans l’armée de Terre et la Gendarmerie et diminuaient significativement avec l’âge. Dans 57,3 % des cas, elles sont survenues en OPEX où elles étaient majoritairement consécutives à des faits de guerre ou d’opérations (85,8 %). Les armes à l’origine des blessures étaient majoritairement des grenades et des roquettes (environ la moitié des blessés déclarés) et les agents vulnérants étaient principalement des éclats et des balles (respectivement 62 % et 28,6 % des blessés). Au total, 43 blessés sont décédés (létalité : 11,8 %) dont 36 (83,3 %) en OPEX (20 en Afghanistan et 11 en RCI). La fiche de déclaration G3 devrait être révisée avec un groupe d’experts du SSA (chirurgiens, médecins d’unité, experts en balistique) afin de mieux prendre en compte des retours d’expérience des théâtres d’opérations et d’adapter la fiche au projet Nato Trauma Registry

). Approximately 3,000 French military personnel are deployed annually in French Guiana, and malaria occasionally affects their operational capabilities.Only military personnel on duty in the Amazon basin are required to take malaria chemoprophylaxis; personnel deployed in coast regions are not. Until February 2001, the chemoprophylaxis regimen consisted of chloroquine (100 mg/d) and proguanil (200 mg/d). During March 2001–October 2003, mefl oquine (250 mg/wk) was used. Since November, 2003 malaria chemoprophylaxis has been doxycycline (100 mg/d), which is initiated on arrival in the Amazon basin. All chemoprophylaxis is continued until 4 weeks after departure. Because of the absence of marketing authorization as chemoprophylaxis by the French Medicines Agency, primaquine was not used until recently. Other individual and collective protective measures did not change during 1998–2008.Despite the availability of chemoprophylaxis, since 2003, several malaria outbreaks have been identifi ed after operations against illegal mining in the Amazon basin (

Objective: Aim of this study was to describe the main characteristics of foodborne disease outbreaks (FBDOs) in the French armed forces from 1999 to 2009.Methods: FBDOs are reported to the military epidemiological surveillance system, which concerns all active military personnel. Investigation reports published from 1999 to 2009 were reviewed.Results: Among the 180 FBDOs reported, 48.3% occurred overseas. The mean reporting rate was 2.4 outbreaks p. 100,000 in France and 26.7 p.100,000 overseas, reaching to 39.3 p. 100,000 in Africa. Digestive symptoms were predominant among cases. Laboratory analyses on cases were positive in 29.4% of FBDOs. The most frequently isolated agents were shigella (15.4%). Laboratory analyses on food samples were positive in 18.9% of outbreaks, the most frequently isolated agent being Clostridium perfringens (15.7%). Only 7 FBDOs were documented by concordant analyses in both patients and food samples.Conclusions: The reporting rate was much higher among military deployed overseas, which can be the consequence of a lack of hygiene due to operational imperatives and the consumption of local food which does not meet safety standards. In operational settings, laboratory evidence may be difficult to obtain and a timely epidemiological investigation in some cases proves valuable to identify the likely vehicle of infection and to guide targeted intervention measures. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Objectives: An outbreak of novel A(H1N1) virus influenza, detected in Mexico in April 2009, spread worldwide in 9 weeks. The aim of this paper is to present the monitoring results of this influenza outbreak among French armed forces.Study design: The period of monitoring by the Military Influenza Surveillance System (MISS) was 9 months, from May 2009 to April 2010.Methods: The main monitored events were acute respiratory infection (ARI), defined by oral temperature >38.5 degrees C and cough, and laboratory-confirmed influenza. Weekly incidence rates were calculated by relating cases to the number of servicepersons monitored.Results: In continental France, the incidence of ARI increased from September 2009, with a weekly maxima of 401 cases per 100,000 in early December 2009 according to MISS. Estimations of the incidence of consultations which could be related to novel A(H1N1) influenza ranged from 48 to 57 cases per 100,000.Conclusions: The trends observed by MISS are compatible with French national estimations. The incidence of consultations which could be related to A(H1N1) influenza at the peak of the epidemic (194 cases per 100,000) was much lower than the national estimate (1321 cases per 100,000). This may be due to servicepersons who consulted in civilian facilities and were not monitored. Other explanations are the healthy worker effect and the younger age of the military population. (C) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

BACKGROUNDOccupational exposure to blood and body fluids (BBFs) is a hazard of many occupations, particularly hospital-based health care providers. However, non-hospital-based health care workers (HCWs) and other personnel not providing health care are also at risk.AIMSTo present the results of surveillance of accidental exposure to BBFs among non-hospital-based French military personnel between 2007 and 2009, comparing different occupational categories.METHODSThe study population included all French military personnel subjected to occupational BBF exposure in a non-hospital setting. BBF exposure was defined as any percutaneous (needlestick injury, scalpel cut, etc.) or mucocutaneous (splash to mucosa, eyes or non-intact skin) exposure to blood, a biological fluid contaminated with blood or a fluid known to transmit blood-borne pathogens.RESULTSBetween 1 January 2007 and 31 December 2009, 704 occupational BBF exposures were reported in non-hospital-based French military personnel. Annualized BBF exposure incidence rates were statistically different among health care workers in non-hospital settings, firefighters, 'gendarmes' and other military personnel, with respectively 38.7, 5.4, 0.8 and 0.1 exposures per 1000 persons per year. Among the 97 cases of HIV post-exposure prophylaxis (PEP) initiated, the source patient's HIV status was unknown in 78 cases (84%).CONCLUSIONSThese results suggest that the appropriateness of HIV PEP initiation in the French military should be reviewed. Adapting French guidelines for managing BBF exposure, for non-hospital-based environments should be considered.

Since the start of 2010 there has been a flare-up of measles in France, following on the resurgence observed in 2008. The aim of this study was to present results of the epidemiological surveillance of measles in the French armed forces and to describe the increase in incidence. Measles was surveyed from 1992 to 2010. Criteria for report were those used for French national compulsory notification. The data, concerning active military personnel, were provided by the physicians in the armed forces using anonymous data collection forms. Between 1992 and July 2010, 689 cases of measles were notified. Since 2002, the mean incidence rate was 1 case per 100,000. A significant increase has been observed for 2010 (13.9 cases per 100,000 in 2010 versus 1.8 in 2009). The 28 cases reported in 2010 involved five clusters and three isolated cases. The mean age of affected subjects was 27 years. Only 30% of cases had been vaccinated. The epidemic resurgence of measles observed in 2010 in the French armed forces follows the same pattern as that observed nationally and at European level, and can be seen as the likely consequence of inadequate vaccination cover.

Objectives. - An outbreak of A(H1N1) virus influenza, detected in Mexico during April 2009, spread around the world in nine weeks. French armed forces had to adapt their epidemiological surveillance systems to this pandemic. Our aim was to present surveillance results.Design. - There are two influenza surveillance systems in French armed forces: one permanent throughout the year and one seasonal, the Military influenza surveillance system (SMOG). The pandemic threat led to an early reactivation of SMOG, before the initiation of a daily surveillance system specifically dedicated to A(H1N1) influenza.Results. - In metropolitan France, the increase of respiratory infections was observed as of September 2009, with a maximum of 401 cases for 100,000 at the beginning of December according to SMOG. The estimated rate of consultations related to A(H1N1) influenza ranged between 46 and 65 cases for 100,000. For military units operating outside of metropolitan France, a peak of incidence was observed in August (400 cases for 100,000).Conclusion. - The trends observed by influenza military surveillance networks were compatible with French ones. Concerning French forces in operations, the increase of incidence observed in August was the consequence of the influenza outbreak in the Southern hemisphere. Estimations of consultations rate related to A(H1N1) influenza, ranged between 127 and 194 cases for 100,000 at the beginning of December, lower than the national rate (1321 cases for 100,000), a consequence of the age pyramid in the military population. (C) 2010 Elsevier Masson SAS. All rights reserved.

OBJECTIVES:An outbreak of A(H1N1) virus influenza, detected in Mexico during April 2009, spread around the world in nine weeks. French armed forces had to adapt their epidemiological surveillance systems to this pandemic. Our aim was to present surveillance results.DESIGN:There are two influenza surveillance systems in French armed forces: one permanent throughout the year and one seasonal, the Military influenza surveillance system (SMOG). The pandemic threat led to an early reactivation of SMOG, before the initiation of a daily surveillance system specifically dedicated to A(H1N1) influenza.RESULTS:In metropolitan France, the increase of respiratory infections was observed as of September 2009, with a maximum of 401 cases for 100,000 at the beginning of December according to SMOG. The estimated rate of consultations related to A(H1N1) influenza ranged between 46 and 65 cases for 100,000. For military units operating outside of metropolitan France, a peak of incidence was observed in August (400 cases for 100,000).CONCLUSION:The trends observed by influenza military surveillance networks were compatible with French ones. Concerning French forces in operations, the increase of incidence observed in August was the consequence of the influenza outbreak in the Southern hemisphere. Estimations of consultations rate related to A(H1N1) influenza, ranged between 127 and 194 cases for 100,000 at the beginning of December, lower than the national rate (1321 cases for 100,000), a consequence of the age pyramid in the military population.

BACKGROUND:Influenza may rapidly disseminate within populations living in confined settings, causing considerable morbidity and disrupting daily activities. The French military health-care system set up since 1994 a prevention strategy based on triennial anti-influenza vaccination. The aim of this study was to evaluate the effectiveness of this strategy during the 2003-2004 influenza season.METHODS:We conducted a matched case-control study from 10/01/2003 through 3/31/2004. Cases were laboratory-confirmed influenza cases. The controls were not to have presented influenza during all the period of study. Controls were matched to cases by sex, army unit and age. Subgroups were categorized into four groups by vaccination regimen [0-1 year], [1-2 years], [2-3 years], [3 years and more or unvaccinated].RESULTS:One hundred and eighteen cases and 435 controls were included. The proportion of correctly vaccinated subjects (</=3 years) was not statistically significant between cases and controls (P=0.22) but the proportion of</=1 year' vaccinated subjects was statistically significant between cases and controls (P=0.01). The effectiveness of the influenza vaccine was 50% (95%CI: 20-70%).CONCLUSION:The results of this study, obtained in an influenza season during which the circulating virus A/Fujian/411/2002 (H3N2) was not perfectly matched with the A(H3N2) component of the influenza vaccine (the most unfavourable case), are compatible with those reported in the literature but do not call into question triennial vaccination. The epidemiologic influenza indicators of the military units show that the impact of influenza did not deteriorate the operational activity of the forces during the study period.