Lyme borreliosis (LB) is the most frequently reported tick-borne disease in Europe, yet no autochthonous case has ever been confirmed in French Guiana (FG). Despite this, patients in FG sometimes attribute persistent, non-specific symptoms to the controversial entity named chronic Lyme borreliosis. This study explores how patients living in a non-endemic region construct and interpret their illness experiences, and how these interpretations shape their interactions with the healthcare system. We conducted a qualitative study involving semi-structured interviews with nine patients previously followed for suspected LB at Cayenne Hospital. Only two had a confirmed or possible LB acquired outside FG; the remaining seven showed no evidence of active or past infection. Thematic analysis revealed four major patterns. First, uncertainty surrounding unexplained symptoms led participants to seek coherent explanatory frameworks, with LB emerging as a meaningful interpretive narrative. Second, a strong epistemic tension was observed between patients lived experience and biomedical knowledge, often resulting in mistrust and perceptions of delegitimization. Third, participants engaged in autonomous diagnostic strategies, relying on online communities and lay expertise to reinterpret symptoms and question biomedical authority. Finally, patients described a state of liminality marked by chronic suffering, social consequences, and a strong desire for recognition and attentive care. Our findings highlight how diagnostic uncertainty, limited local expertise, and structural healthcare constraints contribute to the emergence and persistence of contested diagnoses in non-endemic regions. Beyond biomedical controversies, this study underscores the need for empathetic, rigorous, and dialogical care to restore trust and address the suffering of these patients.

Chikungunya virus (CHIKV) is a mosquito-borne arbovirus that causes acute febrile illness frequently associated with severe polyarthralgia and long-term disabling sequelae. In 2024–2025, La Réunion Island experienced a major resurgence of CHIKV transmission after more than a decade without documented autochthonous circulation. The live-attenuated chikungunya vaccine VLA1553 (IXCHIQ®, Valneva) was recently approved based primarily on immunogenicity data and a validated immune correlate of protection. However, real-world evidence regarding vaccine effectiveness, safety, and population-level impact during active outbreaks remains limited. The CHIK-RE-VAC study aims to evaluate the real-world effectiveness, safety, immunogenicity, and cost-effectiveness of the VLA1553 chikungunya vaccine during an ongoing epidemic on La Réunion Island. CHIK-RE-VAC is an ambispective, observational, multicenter, phase IV cohort study conducted across hospital and outpatient care clusters on La Réunion Island. Eligible adults are enrolled into vaccinated and unvaccinated groups according to their decision to receive vaccination in accordance with national recommendations. The study integrates both prospective recruitment and a retrospective cohort of individuals vaccinated prior to study initiation. Participants are followed for up to 12 months after vaccination or index date with active surveillance, including weekly symptom monitoring and triggered clinical visits. The primary outcome is vaccine effectiveness against laboratory-confirmed symptomatic chikungunya infection at 6 and 12 months. Secondary outcomes include severe disease, hospitalization, adverse events following vaccination, persistent symptoms, health-related quality of life, vaccine acceptability, and cost-effectiveness. A nested immunogenicity substudy evaluates neutralizing antibody responses and cellular immune responses over time. Statistical analyses will use propensity score–based weighting and generalized estimating equation models accounting for clustering. Recruitment began in April 2025 following the launch of a government-funded vaccination campaign targeting populations at high risk of severe chikungunya. An amendment introducing a retrospective cohort was approved in July 2025 to include individuals vaccinated prior to study initiation and to enhance recruitment and statistical power. As of March 2026, 260 participants have been enrolled across the prospective and retrospective components. Recruitment and follow-up are ongoing. The CHIK-RE-VAC study will provide the first comprehensive real-world evaluation of the effectiveness, safety, immunogenicity, and cost-effectiveness of the VLA1553 chikungunya vaccine during an active epidemic. The findings are expected to inform vaccination strategies, public health preparedness, and policy decisions regarding the deployment of chikungunya vaccines in outbreak settings. EU Clinical Trials Register: EU-CT 2025-521307-43-00; ClinicalTrials.gov: NCT06928753.

Abstract Rickettsioses are mild to life-threatening zoonoses caused by obligate intracellular bacteria of the order Rickettsiales (family Rickettsiaceae). Arthropods, including ticks, fleas, and mites, are implicated as their vectors, reservoirs, or amplifiers. With an increasing number of new pathogens and recognition of new pathogenicity and affected geographical areas over the past few decades, there is a better understanding of the scope and importance of these pathogens, particularly as a paradigm to understanding emerging and remerging infections. The taxonomy has undergone numerous changes, with now three main groups classified as rickettsioses according to morphological, antigenic and metabolic characteristics: (1) Rickettsioses due to the bacteria of the genus Rickettsia, including the spotted fever group, typhus groups (Rickettsiaceae), (2) Ehrlichioses and Anaplasmoses due to bacteria of the Anaplasmataceae and (3) scrub typhus due to Orientia tsutsugamushi.

HIV prevalence among cis and trans women sex workers (WSW) is higher than among other women of the same age. It is even higher among migrant women sex workers (MWSW). PrEP is a useful tool for reducing HIV transmission in high-risk populations. The objective of this study was to assess the barriers and action levers to facilitate access to PrEP among MWSW. A qualitative study was conducted, combining semi-structured interviews, informal interviews, and participant observations. In a multi-level approach, our aim was to interview in parallel both MWSW and medical and social workers who frequently interact with them. We observed a significant lack of awareness about PrEP among MWSW. However, some of them showed interest when it was explained by the researchers, and wanted to be more involved in HIV prevention in general. Strong institutional resistance was observed among medical and social workers, mainly justified by a lack of time to address sexual health issues with increasingly precarious sex workers and an inability to provide them with long term follow-up. However, involvement of peer workers in sexual health prevention was considered an option by some medical and social workers. This study highlights individual and institutional barriers to PrEP access for MWSW, along with key facilitators like peer involvement and integrated healthcare approaches. Improving uptake requires culturally and linguistically tailored interventions co-developed with MWSW and better training for healthcare providers to ensure an inclusive approach. Structural changes, including policy reforms and sustainable peer-led funding, are essential to bridge gaps in access and enhance sexual health outcomes for this vulnerable population. Strategies designed to enhance PrEP accessibility for MWSW should be grounded in community empowerment methodologies, leveraging peer-based interventions.

Lyme borreliosis (LB) is a tick-borne zoonosis caused by spirochetes belonging to the Borrelia burgdorferi sensu lato (Bb sl) complex. In Europe, multiple pathogenic species-including B. afzelii, B. garinii, and B. burgdorferi sensu stricto-are responsible for a wide diversity of clinical manifestations. The disease may present in various stages-localized, early disseminated, or late disseminated-depending on the time elapsed since the tick bite and the organs involved, such as the skin, joints, or nervous system. Erythema migrans (EM) is the most frequent clinical presentation, accounting for approximately 80 % of LB cases in France. It is an early localized form, characterized by a painless, centrifugally expanding erythematous lesion centered on the tick-bite site, typically appearing 3 to 30 days post-exposure and resolving within 15 days under antibiotic therapy. Neuroborreliosis (NBL), most commonly associated with B. garinii, occurs in approximately 6-15 % of French cases. It represents a disseminated form, often presenting as meningoradiculitis or peripheral facial palsy, with generally favorable outcomes under antibiotic treatment, although persistent post-infectious symptoms may occur. These guidelines address the full clinical spectrum of LB, from common manifestations such as EM to rare complications involving cardiac or ophthalmological systems. They also encompass atypical presentations not specifically linked to LB and provide specific recommendations for special populations, including pregnant women and immunocompromised patients. The current section summarizes the principal clinical features of LB and supports the rationale underlying recent diagnostic and therapeutic recommendations.

During the 2025 chikungunya outbreak in Réunion Island, two vaccines-IXCHIQ (live-attenuated) and VIMKUNYA (virus-like particle)-received European Union authorization; a local campaign began in April 2025 and was temporarily adjusted for older adults after safety concerns. We assessed vaccine acceptability at the outbreak onset among residents, focusing on people with comorbidities. In January 2025, a cross-sectional web survey yielded 918 complete responses (mean age 44.5 years; 13.1 % prior chikungunya; 53.4 % healthcare workers). Acceptability was highest in the hypothetical full-reimbursement scenario (60.5 %) and was lower among women and those with prior chikungunya; healthcare workers were more likely to accept vaccination. In the hypothetical clinical-trial and self-financed scenarios, acceptability declined to 35.5 % and 20.1 %, respectively, with the same pattern of predictors. Comorbidities showed no significant association. Financing and implementation context, together with gender differences, were key drivers of uptake at the beginning of 2025 outbreak.

BACKGROUND:Toscana virus (TOSV) is a sand fly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis. STUDY DESIGN:The data was gathered from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed. RESULTS:A total of 95 articles including TOSV infections resulting in a total of 1381 cases, were analyzed. Our findings indicate that TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0. The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years. Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count. CONCLUSIONS:These findings underscore the diverse clinical manifestations of TOSV infections including flu like symtomps. TOSV is an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sand flies are actively circulating.

Introduction:Migrant women sex workers (MWSWs) are affected by higher morbidity rates, reflecting the complex health risks associated with sex work and migration which they face. This study aimed to assess MWSWs' use of primary care services in France, as well as the factors associated with having a family doctor. Methods:This cross-sectional observational study of 135 cisgender and transgender MWSWs is part of the larger Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe project, which aims to improve global knowledge of and access to sexual healthcare among this population. MWSWs aged 18 years and older were enrolled over 1 year between 2022 and 2023. The primary outcome was the percentage of MWSWs who reported having a family doctor. A best model analysis and a regression model were used to examine associations between having a family doctor and MWSWs' health and social characteristics. Results:Only 33% of participants reported having a family doctor. Among these, 24% had disclosed they were sex workers to the latter. In general, MWSWs had poor access to preventive healthcare (33% had been HIV tested in the previous year, 33% had used contraception and 19% reported lifetime cervical cancer screening). In contrast, most participants (63.5%) perceived they were in good health. In the multivariate analysis, having a family doctor was not significantly associated with better health outcomes or with the quality of healthcare. Conclusions:The majority of MWSWs did not have a family doctor; this fact compounds existing health vulnerabilities faced by this marginalised population. Improved targeted interventions are needed to increase healthcare access and quality for MWSWs. These interventions should include strategies to enhance communication with healthcare providers about this population's specific needs.

Bacillus cereus can cause severe and potentially fatal bloodstream infections in immunocompromised patients, including preterm neonates. When the infection is nosocomial, investigating a potential environmental source is crucial to mitigate the transmission. This study investigated the potential environmental sources of ten cases of B. cereus bacteraemia in a neonatal intensive care unit. We retrospectively analysed strains from 6 temporal groups of cases involving 10 preterm neonates with bacteraemia (December-2018 to November-2023) and 28 related environmental samples. Strain typing used Multi-locus Sequence Typing (MLST) to identify sequence types (ST), followed by core-genome analysis (cgMLST) and whole genome sequencing (WGS) for strains within the same ST. The 10 clinical strains belonged to 10 different STs, while environmental strains fell into 18 STs. Fourteen strains across four STs matched clinical and environmental sources and were grouped into 4 groups (G1 to G4). Two environmental strains linked to clinical cases were isolated from medical offices, and five from nurses’ locker rooms. These strains were analysed by WGS (Illumina) alongside other Bacillus species. G1 and G2 corresponded to B. cereus species whereas strains of G3 and G4 were closely related to B. pacificus and B. paranthracis, respectively. We determined that severe B. cereus infections cases in 10 preterm neonates were not linked to each other, but rather to multiple potential environmental reservoirs within the NICU, often located farther from clinical wards than expected. These areas are not subject to same hygienic standards as medical units. Our findings highlight the need for routine monitoring of hand hygiene practices along with close surveillance and systematic biocleaning that targets not only direct patient care areas but also the broader hospital environment.

Q fever is a worldwide zoonosis due to Coxiella burnetii, responsible for endocarditis and endovascular infections. Since the 1990s, the combination hydroxychloroquine + doxycycline has constituted the curative and prophylactic treatment in persistent focalized Q fever. This combination appears to have significantly reduced the treatment's duration (from 60 to 26 months), yet substantial evidence of effectiveness remains lacking. Data are mostly based on in vitro and observational studies. We conducted a literature review to assess the effectiveness of this therapy, along with potential alternatives. The proposed in vitro mechanism of action describes the inhibition of Coxiella replication by doxycycline through the restoration of its bactericidal activity (inhibited in acidic environment) by alkalinization of phagolysosome-like vacuoles with hydroxychloroquine. So far, the rarity and heterogeneous presentation of cases have made it challenging to design prospective studies with statistical power. The main studies supporting this treatment are retrospective cohorts, dating back to the 1990s-2000s. Retrospective studies from the large Dutch outbreak of Q fever (>4000 cases between 2007 and 2010) did not corroborate a clear benefit of this combination, notably in comparison with other regimens. Thus, there is still no consensus among the medical community on this issue. However insufficient the evidence, today the doxycycline + hydroxychloroquine combination remains the regimen with the largest clinical experience in the treatment of 'chronic' Q fever. Reinforcing the guidelines' level of evidence is critical. We herein propose the creation of an extensive international registry, followed by a prospective cohort or ideally a randomized controlled trial.

Lyme borreliosis (LB) existence in South America is debated, especially in the Amazon region. The infection with Lyme borreliae has never been reported in French Guiana where Borrelia burgdorferi sensu lato is not found in ticks. We describe the final diagnosis and presumed place of acquisition in patients consulting for suspicion of LB. We retrospectively collected data from all consecutive patients consulting for a suspicion of LB between 2010 and 2021 at Cayenne Hospital, French Guiana. Patients were classified by an adjudication committee as confirmed LB if they met the criteria of the French consensus, as possible LB if they had compatible symptoms and a good outcome after appropriate treatment, or excluded when a differential diagnosis was found. The place of acquisition was discussed in case of possible or confirmed case. Twenty-six patients were included. Rheumatologic symptoms were the most reported (88 %) followed by neurological symptoms (61 %). Twenty-four (92 %) of these patients were born out of French Guiana. Diagnosis of LB was considered as confirmed in 2 patients (8 %), for whom the place of acquisition was likely mainland France, and as possible in 3 patients (11 %) with early localized LB presumably acquired in French Guiana. Functional somatic disorders were diagnosed in 13 (50 %) patients whereas 9 (35 %) were found with another disease. This study did not confirm the acquisition of LB in French Guiana. However, three possible autochthonous cases encourage clinicians working in the Amazon area to stay aware of LB.

Background: Toscana virus (TOSV) is a sandfly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis. Study design: We gathered data from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed. Results: In our review a total of 95 articles including TOSV infections resulting in a total of 1,381 cases were analyzed. Our findings indicate, TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0 (p<0.001). The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years. Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count. Conclusions: These findings underscore the diverse clinical manifestations of TOSV infections and highlight the importance of considering this pathogen in the differential diagnosis of patients presenting with acute febrile illness, especially in endemic regions. TOSV represents an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sandflies are actively circulating. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by European Commission grant 101057690 and UKRI grants 10038150 and 10039289, and is catalogued by the CLIMOS Scientific Committee as CLIMOS (http:// www.climos-project.eu). The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission, the Health, and Digital Executive Agency, or UKRI. Neither the European Union nor granting authority nor UKRI can be held responsible. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. For the purposes of Open Access, the authors have applied a CC BY [option: CC BY-ND] public copyright license to any Author Accepted Manuscript version arising from this submission. CLIMOS forms part of the Climate Change and Health Cluster comprising six Horizon Europe projects: BlueAdapt, CATALYSE, CLIMOS, HIGH Horizons, IDAlert, and TRIGGER. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

BACKGROUND:Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end. OBJECTIVES:To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. METHODS:In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach. RESULTS:The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. CONCLUSION:GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.

Background Immunization against the Yellow fever virus (YFV) with the 17D live-attenuated vaccine is the most effective way to prevent the disease. However, unexpected severe adverse events can occur. They consist in a neurological impairment - neurological disease (YEL-AND), a YF-like illness - viscerotropic disease (YEL-AVD) or anaphylaxis. In this article, we describe the epidemiology, clinical and biological features of YEL-AND and YEL-AVD cases reported to the French National Reference Center for Arboviruses (NRCA) in the past 10 years.Methods We conducted a national, retrospective study using the database of the NRCA from June 2012 to June 2022. All patients whose biological samples were sent to the NRCA for detection of YFV by serology and/or RT-qPCR for a suspected vaccine-associated adverse event were included. We collected data by reading medical records and conducted complementary neuro-immunological analysis, followed by a search for autoimmunity against type-1-interferon when samples were available at the NRCA.Results There were 10 cases of YEL-AND and 2 cases of YEL-AVD reported to the NRCA in the past 10 years, which represented an overall incidence of 0.6 for 100 000 doses. A total of 6/12 cases were previously healthy patients (50%, mean age 31 years), and 4/12 cases had cardiovascular co-morbidities (42%, mean age 56 years). The majority of YEL-AND had a favourable outcome at 6 months of follow up. One YEL-AVD patient passed. In secondary analyses, we evidenced a significant blood cerebrospinal fluid (CSF) barrier dysfunction, without intrathecal synthesis of immunoglobulin and without argument for a neuron damage. We further detected a significant rate of anti-type-1alpha interferon antibodies in 3/10 tested patients (2 YEL-AND and 1 YEL-AVD).Conclusion YEL-AND and YEL-AVD are rare events that can underlie defect in the innate immunity of apparently healthy or mild co-morbid subjects. Outcome was generally favourable in the YEL-AND cases of our series, but still life-threatening or even fatal in the YEL-AVD cases.

IntroductionGiven the high infection rate of sexually transmitted infections (STI) among migrant women sex workers (WSWs), it is necessary to understand how to improve prevention, information and care for this vulnerable population. Community health workers (CHWs), by linking community to health services, are positioned to improve health outcomes in migrant communities. This article aims to describe a pilot innovative intervention performed by CHWs to improve sexual health in migrant WSWs.MethodsThis one-year intervention study used a respondent-driven sampling (RDS) to recruit a representative cohort of migrant WSWs in Marseille, France. Four CHWs were recruited from different communities and participated in all stages of the research. They performed individual and group interventions of prevention, support in care and empowerment. Data on participant characteristics, type of intervention and adherence to the intervention were reported via questionnaires given to participants. Simultaneously, semi-structured interviews and informal interviews of migrant WSW, CHWs and care providers were carried out.ResultsA total of 132 migrant WSWs were included in the cohort. Very few of them knew about PrEP (12%) or already used HIV post-exposure treatment (9%). Migrant WSWs were often victims of rape or racism, 15 and 21%, respectively. In two-thirds of cases the level of health literacy was low. Participants suffered from a combination of vulnerability factors: difficulties with access to social rights, food or housing. Only 13% reported having benefited from medical follow-up or assistance by an NGO in the 3 months prior to the program. By 3 months, more than one third of the participants had been tested for HIV (35%) and 63% knew about PrEP. A total retention rate of 70% was reported in the cohort after 6 months.ConclusionCHWs enabled to improve care access for migrant WSWs by improving the collaboration between care and social actors at a local level. Through these “bring-back-to” interventions for this hard-to-reach population, CHWs enabled an optimization of the care pathway. Our results also highlight the importance of a population-based approach for individual and group support of empowerment interventions in order to strengthen their capacity for action.

Abstract Background and objectives: Subjective nonspecific symptoms can persist after well-treated Lyme disease (LD) (known as post-treatment Lyme disease syndrome). On the other hand, a link between borreliosis andso-called chronic Lyme disease (CLD) has never been demonstrated, while approximately80% of patients with suspected LD suffer from another disease. However, these patients are truly suffering and wonder for an explanation for their pain. The aim of this study was to focus for the first time onthe care pathway of patients assessed for a suspected LD in French Guiana. Methods: We performed a qualitative study with semiconducted interviews. All patients assessed for a suspicion of LD at the Hospital of Cayenne could be included, regardless of whether the diagnosis was confirmed. Results: Nine patients were interviewed. Four major themes were highlighted after analysis: a long pathway to a diagnosis, an opposition between patients and the healthcare system, a lonely medical journey, and a negative impact of the disease on quality of life. Self-diagnosed CLD is still a challenging reason forconsultation, supported by the over mediatization of LD and an opposition with the healthcare system. This opposition is highlighted in French Guiana, where no LD is described to date and whereaccess to healthcare is different as in mainland France. Conclusion: Patients with nonspecific symptoms attributed to LD are truly suffering and are asking for a listening ear. An empathic but rigorous approach is needed to manage these patients, to find a possible differential diagnosis and to improve patient care.

Antibiotic therapy duration is a major public health issue worldwide. Shortening antibiotic treatment is a way to limit the use of antibiotics and to limit adverse effects, costs, and the risks related to the emergence of antibiotic resistance. The consensus is to treat patients with the shortest possible duration of the antibiotic treatment without compromising the effectiveness of said treatment. However, observation shows that there is still progress to be made for the correct prescription of antibiotics in Europe.

BACKGROUND:The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection. However, at-risk women very rarely use PrEP in France-this represents a critical issue among migrant women sex workers (MWSWs). Previous studies on PrEP use among women sex workers or migrants focused on individual or social determinants of motivation. However, operational studies in real-word settings using a holistic population approach to maximize PrEP adherence among MWSWs are lacking. OBJECTIVE:FASSETS (ie, "Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe"; English: "facilitate the access to Sexual Health in women sex workers") is a participative, multilevel, mixed methods study aiming to improve global knowledge of and access to sexual health care and PrEP among MWSWs through targeted empowerment strategies. METHODS:This study comprises several phases: (1) phase 1: an initial qualitative study combining semistructured interviews, informal interviews, and participative observations will be performed among MWSWs, local community nongovernmental organizations, and institutions providing sexual reproductive health services to identify the determinants of PrEP access among MWSWs and for respondent-driven sampling (RDS); (2) phase 2: the size of the hidden MWSW population is estimated in Marseille through capture-recapture (the RDS survey will serve as "recapture"); (3) phase 3: a longitudinal cohort will be formed through RDS to represent the MWSW population with a goal of 150 inclusions-this cohort will be followed up for 12 months, and sequential questionnaires exploring medical history; knowledge of sexual health, HIV, and sexually transmitted infections; migration route; and current living conditions will be administered at inclusion (month 0) and months 3, 6, and 12 to measure the following interventional phase's outcomes; and (4) phase 4: an interventional study with community empowerment actions about sexual health and PrEP will be conducted with community health workers; standardized questionnaires and semistructured interviews, observations, and focus groups will highlight MWSWs' experiences with empowerment resources, concerns about sexual health, and especially PrEP use or uptake, and we will evaluate whether and how community-adapted empowerment actions conducted by community health workers are effective in increasing access to sexual health, prevention and screening of sexually transmitted infections, and PrEP knowledge and access among MWSWs. RESULTS:Recruitment commenced on March 1, 2022. We estimate the follow-up period to end on September 30, 2023. CONCLUSIONS:This multiphase study will provide robust evidence about the magnitude of the MWSW population in Marseille (the second largest town in France) and their current conditions of living, access to and knowledge of sexual health, and PrEP access. Using a mixed methods analysis, we will investigate whether individual and collective community health empowerment approaches can facilitate access to PrEP and its initiation, use, and adherence in this vulnerable population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/42844.

The clinical characteristics and epidemiology of Q fever in the Tropics are poorly described. We performed a retrospective cohort study of hospitalized cases between 2004 and 2017 in Reunion Island. Acute Q fever was defined in presence of a positive serology (phase II IgG ≥ 200 and phase II IgM ≥ 50), or a seroconversion (4-fold increase in phase II IgG between paired samples), or a positive PCR (blood or serum). Forty-two cases matched the diagnostic criteria. The most common clinical manifestations were fever (85.7%) and pulmonary symptoms (61.9%), including pneumonia (45.2%). Ninety percent of the patients were living in a farming area. Cumulative incidence was estimated at 9.3 per 100,000 inhabitants (95%CI: 6.4–12.1) with cases diagnosed yearly all throughout the study period except in 2006. Together with the seroprevalence figures, these data suggest that Q fever reaches low to moderate endemic levels on Reunion Island. As previously reported, pulmonary symptoms are in the foreground.