Les coronavirus humains OC43 (HCoV-OC43) sont des agents communs, notamment chez les jeunes enfants, d'infections des voies respiratoires hautes et parfois basses. Ils appartiennent au genre Betacoronavirus et sont génétiquement très différents d'autres HCoV incluant les HCoV-229E et -NL63. De plus, il a été décrit que l'épidémiologie et la symptomatologie associées à leurs infections différent de celle des autres HCoV. Depuis 2017, nous réalisons au laboratoire de microbiologie et virologie clinique de notre centre hospitalo-universitaire (CHU) l'identification des HCoVs. Nous décrivons ici les caractéristiques épidémiologiques et cliniques des infections à HCoV-OC43 diagnostiquées au cours des trois dernières années. Les prélèvements respiratoires testés pour la présence du HCoV-OC43 ont été ceux adressés de janvier 2017 à décembre 2019 pour recherche de virus respiratoire au laboratoire de diagnostic microbiologique et virologique de notre CHU. Le diagnostic de HCoV-OC43 a été réalisé par PCR en temps réel avec les trousses FTD Respiratory pathogens 21 (Fast Track Diagnosis, Luxembourg) ou Biofire Filmarray Respiratory panel 2 plus (Biomérieux, France). Un total de 16 357 prélèvements respiratoires de 11 976 patients ont été testés au cours de la période de l'étude (3 ans). Un HCoV a été détecté dans 554 prélèvements (3,4 %) obtenus de 483 patients (4 %). HCoV-OC43 a été détecté dans 157 prélèvements (1,0 % ; 29 % de ceux HCoV-positifs) de 136 patients (1,1 % ; 28 % des patients HCoV-positifs) : 66 femmes et 70 hommes (sex-ratio H :F = 1,1). L'âge moyen des patients HCoV-OC43-positifs était de 36 ± 34 ans (min.–max. : 0–97 ans) avec respectivement 26 (19 %), 26 (19 %), 7 (5 %), 4 (3 %), 9 (7 %), 23 (17 %), 17 (12 %) et 24 (18 %) patients de < 1, 1–5, 5–15, 15–25, 25–45, 45–65, 65–75 et > 75 ans. Deux pics d'incidence ont été observés en octobre 2017 lorsqu'ils ont représenté 83 % des infections à HCoV et en septembre-octobre 2018 (81 %). Douze patients HCoV-OC43-positifs (9 %) ont été admis en réanimation. Trois (2,2 %) sont décédés : une femme de 95 ans institutionnalisée ayant présenté une pneumopathie sans co-infection, un nourrisson de 10 mois ayant présenté hypoxie d'étiologie inconnue, et un homme de 77 ans ayant présenté une pneumopathie sur cancer pulmonaire et co-infecté par Streptococcus pneumoniae. Cette large série de cas montre que les HCoV-OC43 sont dans notre CHU une cause non négligeable d'infections respiratoires touchant particulièrement les âges extrêmes et pour lesquelles il n'existe pas actuellement de médicament actif approuvé. Ces résultats justifient d'inclure systématiquement dans le diagnostic des infections respiratoires le dépistage et l'identification des HCoV-OC43 qui restent des virus négligés. Ceci permettra de mieux caractériser l'épidémiologie, la symptomatologie, les co-infections et la mortalité associés à leurs infections.

La surmortalité causée par la résistance aux antibiotiques est un problème actuel de santé publique. Des études basées sur des modèles mathématiques ont été réalisées pour tenter d’estimer cette surmortalité, mais ces modèles sont approximatifs et sujets à controverse. Au sein de notre laboratoire, nous avons mis en place un système de surveillance hebdomadaire de la mortalité due à la résistance bactérienne. L’objectif de ce travail est d’évaluer le véritable impact de la résistance bactérienne sur la mortalité au sein de nos hôpitaux. Nous avons réalisé une étude rétrospective cas-témoins entre janvier 2014 et janvier 2018. Les données analysées sont issues du service médical de l’information de l’hôpital et de notre logiciel de surveillance. Les données de résistance aux antibiotiques clés ainsi que l’évaluation du nombre de bactéries DTR ont été recueillis pour chacun des deux groupes pour les 10 bactéries les plus fréquemment isolées dans les hémocultures. Les facteurs de risque d’acquisition de ces souches ont été évalués par régression logistique. Le logiciel R a été utilisé pour les statistiques. Nous avons reçu un total de 375 165 hémocultures dont 36813 (9,81 %) étaient positives correspondant à 11946 patients. Parmi eux, 1715 (14,35 %) patients sont décédés. Le nombre d’infections polymicrobiennes était plus élevé dans le groupe des décès (9,4 %) que dans le groupe contrôle (6,8 %) (p = 0,004). Les bactéries à Gram négatif représentaient 72,2 % des co-infections dans le groupe décès contre 48,6 % dans le groupe contrôle. Les facteurs de risque associés à la mortalité étaient l’âge > 60 ans, le sexe masculin, un long séjour à l’hôpital et l’acquisition nosocomiale. La prévalence de la résistance à la ceftriaxone (24 % vs 14,2 % ; p < 0,001) et à la ciprofloxacine (31,3 % versus 21,8 % ; p = 0,009) étaient significativement plus élevée dans le groupe des décès pour Escherichia coli. Pour Klebsiella pneumoniae, la prévalence de la résistance à l’imipénème était plus élevée (2,2 % vs 0,4 % ; p = 0,05). Pour Pseudomonas aeruginosa, le taux de résistance à l’imipénème (35,5 % vs 18,9 % ; p = 0,007) et la ciprofloxacine (26,2 % vs 13,8 % ; p = 0,01) était statistiquement significatifs. Il n’existait pas de différence en terme de résistance pour les bactériémies causées par les bactéries à Gram positifs analysés entre les deux groupes. Sur les 9078 patients analysés, 26 (0,28 %) étaient infectés par une souche DTR (13 cas dans chaque groupes). P. aeruginosa était l’espèce la plus rencontrée avec ce phénotype (12 ; 46,15 %), suivie d’Acinetobacter baumannii (7 ; 26,9 %). Pour ces souches, la colistine restait l’antibiotique de 2e ligne le plus actif, suivi de la tigécycline et de l’amikacine. Le taux de résistance de certains antibiotiques clés était plus important dans le groupe des patients décédés que dans le groupe des patients survivants. Ces antibiotiques sont essentiellement ceux utilisés en traitement empirique, suggérant que dans certains cas, celui-ci n’est pas adapté. Le recueil des traitements reçus par les patients est en cours. Le nombre de souches DTR dans les deux groupes étaient par contre très faible, suggérant que l’utilisation d’antibiothérapie de 1ere ligne est possible dans la grande majorité des cas. Dans tous les cas, il existait une alternative thérapeutique.

Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45-93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture-negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases.

Staphylococcus saprophyticus is one of the leading causes of urinary tract infections (UTI). In December 2014, our surveillance system identified an abnormal increase in S. saprophyticus causing UTIs in four university hospitals in Marseille, indicating a suspected community S. saprophyticus UTI outbreak. This was detected by our surveillance system BALYSES (Bacterial real-time Laboratory-based Surveillance System). S. saprophyticus/ Escherichia coli UTI ratio increased three-fold from 0.0084 in 2002 to 0.025 in December 2015 in Marseille with an abnormal peak in December 2014, and with an annual estimated ratio trend of 5.10−6 (p-value < 10−3). Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS) spectral analysis of strains was used to analyse strains cluster expansion, comparing strains from Marseille to those from Nice during the same period. MALDI-TOF MS spectral analysis revealed a geographical restricted clonal expansion of the strains clusters in Marseille as compared to Nice. Our finding suggests (i) a geographically restricted expansion of a specific S. saprophyticus strain clusters circulating in Marseille, and (ii) MALDI-TOF MS can be used as a cost-effective tool to investigate an outbreak.

Digital tools cannot be separated from their users, the activities for which they are built, and their utilisation context. They require from professionals a learning of how to work with systems that are more or less easy to use, and a modification, sometimes complete, of their practices and organisations. It is why this chapter introduces a human factor approach of medical informatics, and specifically a work analysis approach, which is a methodological approach aiming to collect essential data in order to describe the psychological, physical, social, technical and economic conditions within which an operator performs a set of tasks or activities that constituted his work. After presenting the overall context of computerisation pressure associated with the evolution of health work systems and the possible risks and stakes it brings, this chapter describes the concepts of ergonomics and human factors for medical informatics projects. It specifically focuses on work situation analysis, user-centered design with a practical example concerning the implementation of a CPO system, and concludes with a broader approach opening the concept of medical socio-technical system.

This chapter presents potential uses of information and communication technologies (ICTs) for public health, with a special focus on decision-making and decisional support systems. An overview of public health sub-domains is given as potential functional areas for ICTs and business intelligence. The specifics and principles of decision-making for public health policy are explained. Main methods and observational tools used in epidemiology are overviewed. Relevant decisional support architectures are presented, ranging from data warehouse techniques, geographical information systems and simulation tools. The relevance and reusability of medico-administrative data sources is discussed, and balanced with data from registries and cohort studies in the perspective of evidence-based decisional support systems for public health. Last, public health decisional support systems are discussed as tools for translational research in public health.

Introduction: We examined the process of decision making related to diagnosis in paramedic teams in an international competition. Method: Observation of 28 paramedic teams in selected task was compared with objective medical evaluation of their performance in the whole competition. Results and discussion: The real process of examining the patient and establishing the diagnosis by the paramedics is not in accordance with the prescribed procedures. Paramedics show a tendency to make assumptions about the case from early steps of dealing with it, which has a strong influence on the subsequent process of examination of the patient and establishing diagnosis.

La surveillance épidémiologique dans l’OTAN est née en 1995 en Bosnie-Herzégovine avec la mise en oeuvre du système EpiNATO. Ce système, souffrant de nombreux défauts le rendant peu efficace au regard de ses objectifs, est actuellement le seul système de surveillance épidémiologique propre à l’OTAN. La surveillance épidémiologique de l’Alliance repose donc en grande partie sur les systèmes nationaux. Le Deployment Health Surveillance Capability (DHSC) est un service créé à Munich en 2010 à partir d’une initiative franco-allemande et dont l’objectif est de devenir le centre d’épidémiologie des déploiements de l’OTAN. Ses missions actuelles sont de réécrire la doctrine de la surveillance épidémiologique des déploiements (AMedP-21), de moderniser le système EpiNATO pour le rendre plus efficace et adapté aux formes actuelles de déploiement et de développer l’interopérabilité du système français ASTER (Alerte et Surveillance en Temps Réel) dans l’optique d’une utilisation par l’OTAN lors des futures opérations.

We conducted an exploratory study of a complex and dynamic medical activity, namely the collective management of an epidemiological alert situation. With a view to improving our knowledge of how this activity is managed, we set up simulated situations of epidemiological alerts. A multidisciplinary medical team was assisted by a decision-support system called ASTER and we recorded a set of systematised observations of human–human and human–machine interactions. Participants were physicians belonging to the Department of Epidemiology at the French Army's Institute of Tropical Medicine. After presenting the epidemiological domain and our theoretical approach, we describe the simulated situation and the communication dataset we collected and analysed, applying the EORCA method. Finally, in our discussion of the results, we suggest how communication could be enhanced between technology-mediated teams in complex and dynamic situations.

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.

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.

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.

CONTRIBUTION TO AN EVENT REPRESENTATION OF MEDICAL COLLABORATIVE ACTIVITIES: THE EXAMPLE OF SYNDROMIC SURVEILLANCE FOR EARLY WARNING. We propose an observation and formalization method to describe individual and collective activities performed by a medical team. The goal of this paper is to introduce this method (EORCA) and to illustrate its application in the case of a medically complex, uncertain and time-constrained situation: the management of an outbreak early warning by epidemiology specialists. This method comprises two main steps: the formal observation of medical staff's activities that occur during medical situation management and a representation of the findings with regard to an ontology and a temporal flowchart, which describes actors and events related to patient management. The application of this method in the case of this situation is based upon collaborative activities. It shows that the management of an epidemiological early warning is characterised by collective activity. Numerous information transmissions are required between members of the team. Its goal is to identify diseases and to prepare adequate actions in a context of uncertain events and in a short interval of time. Elements of cooperative activities between actors were outlined in our observations: namely, the actors jointly develop a set of structured and complex processes and the allocation of tasks among the actors (e.g., parallel or successive actions) depends on the complexity and urgency of the situation. We have observed that tasks were jointly performed by a set of caregivers sharing the same objectives and were based on a mutual and distributed understanding of intentions and actions. The results of this study illustrate the setting up of a shared problem representation, implying a strong element of cooperative work in a decision-making process. In this context, multiple and possibly divergent interpretations of problems may arise and co-exist. This is especially observed when actors are faced with a problem that is characterized by a high level of complexity and/or lack of accurate data, or do not have access to the relevant knowledge needed to fully understand the problem.

OBJECTIVE The pilot near real time surveillance system ASTER, which currently monitors the French Forces in Djibouti and French Guiana [1], has been especially designed for inter-allied interoperability. This paper briefly describes the rationale of this system’s interoperability framework and components, and its results from a 4 years long experience. BACKGROUND Surveillance for health threats within allied deployed forces raises several operational constraints related to geographical spread of health-care data sources, nation-dependent information management and organization, data military classification, patient privacy, information accuracy and timeliness. These constraints advocate against a central data warehousing, and uphold a solution where data stay in-situ and where surveillance is done using real-time convenient queries against the data sources. METHODS The ASTER system adopts a lightweight interoperability approach using a logical model of epidemiological events [2] with the OpenEHR archetypes paradigm [3] and the CEN/TC251 prEN13606 standard. This approach is a “plug-and-play” semantic interoperability build upon a specific knowledge representation that avoids the rigidities of message-based standards, as HL7 or Edifact.