La propagation à Bamako en novembre 2014 de l’épidémie de maladie à virus Ebola a constitué une menace pour les militaires français déployés au Mali. Le Service de santé des armées a dû mettre en œuvre des mesures visant à évaluer la réalité du risque et son évolution, à protéger les forces d’une transmission, et à se préparer à dépister, prendre en charge et évacuer un éventuel cas possible ou confirmé de maladie à virus Ebola.

Les militaires sont exposés à des risques et contraintes particuliers du fait de leur profession. Le service de santé des armées et la caisse nationale militaire de sécurité sociale ont pour objectifs d'améliorer la santé des militaires en mettant en œuvre des plans de santé et de prévention tenant compte de ces spécificités. Afin d’élaborer ces plans, une enquête d'envergure, nommée enquête nouvelle génération a été conduite en 2019 pour actualiser les connaissances sur la santé et les besoins en prévention des militaires. Cette étude transversale observationnelle par questionnaire a été menée en présentiel auprès d'un échantillon aléatoire de 4266 militaires d'active des quatre forces armées et des services communs stationnés en France métropolitaine. La majorité des militaires interrogés jugeait bonne ou très bonne, leur santé physique (pour 81 % d'entre eux) et mentale (77 %). Près de la moitié n'avait pas rencontré de problème de santé dans les 12 derniers mois. Les troubles musculosquelettiques étaient les plus fréquemment cités. Les militaires rapportaient également plusieurs troubles en santé mentale. En mission, 30 % avaient rapporté un problème de santé, principalement des diarrhées ou de la traumatologie accidentelle. Les thèmes de prévention jugés prioritaires par les militaires variaient selon leur contexte de vie (métropole ou déploiement en mission) et concernaient principalement les lombalgies, l'alcool, le stress et les états de stress post-traumatiques, les maladies à transmission vectorielle, et l'hygiène. Ces résultats importants complètent ceux obtenus par d'autres enquêtes ou par la surveillance épidémiologique des armées, et nourrissent un travail multidisciplinaire sur les futurs plans de santé à co-construire avec le commandement et les acteurs concernés. L'objectif recherché est de contribuer à l’évolution de l'offre de soins et des mesures de prévention proposées à la population militaire française pour tenir compte de ses spécificités et répondre à ses attentes. Les auteurs déclarent ne pas avoir de liens d'intérêts.

Objectives: Acquisition of extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-E) by Europeans travelling individually in high-endemicity countries is common. However, how the different ESBL-E strains circulate in groups of travellers has not been studied. We investigated ESBL-E transmission within several groups of French military personnel serving overseas for 4e6 months. Methods: We conducted a prospective study among French military personnel assigned to Afghanistan, French Guiana or C<^> ote d'Ivoire for 4e6 months. Faecal samples provided by volunteers before leaving and after returning were screened for ESBL-E isolates. ESBL Escherichia coli from each military group was characterized by repetitive element palindromic polymerase chain reaction (rep-PCR) fingerprinting followed, in the Afghanistan group, by whole-genome sequencing (WGS) if similarity was >= 97%. Results: Among the 189 volunteers whose samples were negative before departure, 72 (38%) were positive after return. The highest acquisition rates were observed in the Afghanistan (29/33, 88%) and Cote d'Ivoire (39/80, 49%) groups. Acquisition rates on return from French Guiana were much lower (4/76, 5%). WGS of the 20 strains from the Afghanistan group that clustered by rep-PCR identified differences in sequence type, serotype, resistance genes and plasmid replicons. Moreover, single-nucleotide polymorphism (SNP) differences across acquired strains from a given cluster ranged from 30 to 3641, suggesting absence of direct transmission. Conclusions: ESBL-E. coli acquisition was common among military personnel posted overseas. Many strains clustered by rep-PCR but differed byWGS and SNP analysis, suggesting acquisition from common external sources rather than direct person-to-person transmission. (C) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

La lutte contre les infections sexuellement transmissibles (IST) et le virus de l'immunodéficience humaine (VIH) représentent un enjeu important de la prévention dans les armées, constituées d'une population jeune plus sujette aux comportements à risque. L'objectif de ce travail est de faire un état des lieux de la prévention des IST et du VIH chez les militaires, et d'étudier les déterminants d'un moindre recours au dépistage. Les données analysées étaient issues d'une étude transversale portant sur un échantillon représentatif de 1500 militaires d'active ayant répondu à un questionnaire auto-administré en 2014/2015, dont 1000 ont accepté la réalisation de prélèvements biologiques. Les 1482 sujets (1250 hommes et 232 femmes) ayant eu au moins un rapport sexuel au cours de leur vie ont fait l'objet de notre analyse. Les associations entre les variables étaient recherchées par test exact de Fisher si les conditions d'application du test du Khi2 n'étaient pas remplies. L'étude des déterminants d'un moindre recours au dépistage a été réalisée au moyen de modèles de régression logistique uni- puis multivariée. Le seuil de signification était fixé à 5 % pour l'ensemble des analyses, réalisées avec le logiciel Stata®/SE1 3.0 (College Station, TX, États-Unis). L'ensemble des analyses était pondéré pour tenir compte du plan de sondage complexe et de la post-stratification réalisée. Une exposition sexuelle à risque dans les 5 dernières années était rapportée par 44,7 % des hommes et 55,1 % des femmes. Aucun dépistage (VIH et IST) n'avait été réalisé avant l'étude chez 27,7 % des hommes et 16,5 % des femmes. Chez les hommes, les déterminants de l'absence de tout dépistage étaient l'âge inférieur à 35 ans (p = 0,007), l'absence de rapports sexuels tarifés (OR : 2,0 [1,3–2,9], p = 0,003), de multipartenariat (OR : 2,0 [1,5–2,7], p < 10−4), d'information individuelle (OR : 1,8 [1,3–2,6], p = 0,004] et d'éducation pour la santé (OR : 1,8 [1,0–3,1], p = 0,048). Chez les femmes, il s'agissait d'un niveau d'études inférieur au bac (OR : 3,8 [1,2–12,3], p = 0,028), de l'absence de multipartenariat (OR : 2,6 [1,3–5,1], p = 0,01) et de l'absence de crainte des IST (OR : 3,8 [1,8–7,8], p = 0,002). Parmi 42 diagnostics d'IST (6 % [4,1–8,7]) confirmés par prélèvement biologique au moment de l'étude, 37 concernaient des hommes n'ayant signalé aucun antécédent d'IST. Aucune des 11 femmes (12,8 %) dont le dépistage au moment de l'étude permettait de diagnostiquer une IST n'avait rapporté d'antécédent similaire. Nos résultats suggèrent qu'un axe important pour améliorer la prévention du VIH et des IST dans les armées est l'amélioration du dépistage pour qu'il soit mieux ciblé sur les sujets les plus à risque. Cela ouvre la voie à la modification des messages délivrés lors de la formation initiale et continue des médecins, mais également de tous les acteurs dans le domaine de la santé des militaires. La perception du risque individuel est en effet un facteur majeur dans la démarche de dépistage volontaire dans ce domaine.

Objectives: French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to present the results of surveillance of vaccine adverse events (VAEs) reported from 2011 to 2012 in the French armed forces.Study design: VAEs were surveyed among all French armed forces from 2011 to 2012 by the epidemiological departments of the military health service. For each case, a notification form providing patient and clinical information was provided.Methods: Case definitions were derived from the French drug safety guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAEs to the number of vaccine doses delivered.Results: In total, 161 VAE cases were reported. The overall VAE reporting rate was 24.6 VAEs per 100,000 doses, and the serious VAE rate was 1.3 per 100,000 doses (nine cases). The serious VAEs included two cases of Guillain-Barre syndrome, one case of optic neuritis, one case of a meningeal-like syndrome, one case of rheumatoid purpura, one case of acute asthma and three cases of fainting. The highest rates of VAE were observed with the Bacille Calmette-Guerin vaccine (BCG) (482.3 per 100,000 doses), inactivated diphtheria-tetanus epoliovirus with acellular pertussis vaccine (dTap-IPV) (106.1 per 100,000 doses) and meningococcal quadrivalent glycoconjugate vaccine (MenACWY-CRM) (39.3 per 100,000 doses).Conclusions: The global rates of VAE observed in 2011 and 2012 confirm the increase that has been observed since 2009 in the French armed forces, which could reflect improved practitioner awareness about VAEs and the use of certain vaccines added to the vaccination schedule recently (dTap-IPV in 2008 and MenACWY-CRM in 2010). VAEs appear to be relatively rare, particularly serious VAEs, which indicates acceptable tolerance of vaccines. (C) 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

In stays in tropical countries, the French military, and travelers in general, are exposed to diseases transmitted by the fecal-oral route, some of which are vaccine-preventable. Here we report a 42-yer-old soldier with hepatitis A, which first appeared on his return from a military operation in the Central African Republic. Despite its excellent immunogenicity and a duration of seroprotection extending beyond 20 years in the vast majority of cases, the hepatitis A vaccine can fail. This reminds us of the importance of combining vaccine and non-vaccine prevention in tropical countries, especially in precarious living conditions.

L’utilisation d’un vecteur aérien pour transporter un patient, un blessé, est aujourd’hui usuelle. La quasi-banalisation de cette mission ne doit pas dissimuler le risque qui en découle. Le but de cette étude est d’identifier si la présence à bord d’une équipe médicale ou d’un patient, un blessé peut conduire les équipages de conduite à prendre plus de risques. Un auto-questionnaire anonyme a dans ce sens été adressé à presque 900 pilotes et copilotes de l’aéronautique étatique (ministère de la Défense et ministère de l’Intérieur). Outre l’intérêt du personnel navigant concerné, cette étude a mis en évidence une influence de l’équipe médicale sur les décisions de l’équipage dans la conduite de la mission.

Introduction Pertussis, measles, rubella and varicella are vaccine preventable diseases that can lead to severe perinatal consequences in the absence of vaccination. The objective of our study was to estimate the vaccination rate for these diseases among young parents just after the birth of their child, and to seek for risk factors of low vaccination coverage and low acceptance rate of vaccination.Material and Methods Parents of every children born from February to May 2013 at the …

L’objectif de l’article était de présenter un état des lieux des conduites addictives dans les armées françaises. Lesdonnées (auto-questionnaire et dépistage urinaire du cannabis) de quatre enquêtes de prévalence menéesentre 2005 et 2009 ont été agrégées. Les prévalences pour l’ensemble des armées (n=4 208) étaient de 48 % pourl’usage actuel de tabac, 15 % pour la dépendance tabagique, 48 % pour l’usage régulier d’alcool, 21 % pourl’ivresse au cours du dernier mois, 14 % pour la dépendance alcoolique, 13 % pour le dépistage urinaire ducannabis et 6 % pour l’usage d’autres drogues illicites dans l’année. La marine et les pompiers présentaient lesplus forts risques d’ivresse alcoolique, l’armée de terre étant plus à risque de dépendance. L’usage de cannabis etl’ivresse alcoolique concernaient surtout de jeunes hommes militaires du rang. Les prévalences et déterminants desusages en milieu militaire apparaissent proches de ce qui est observé en population générale dans les mêmestranches d’âge. Les différences observées entre armées pourraient refléter certaines de leurs spécificités.

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.

Teenager sexuality is a public health issue. In teenagers attending a high school, we assessed their knowledge and behavior on sexuality, infectious transmitted diseases, human papilloma virus (HPV) vaccination, and cervical cancer. Then in girls, we estimated the anti-HPV vaccination coverage and focused on factors associated with poor knowledge of these topics.Methods. This was a knowledge, attitudes, and practices cross-sectional study conducted at the beginning of the 2010-2011 school year in the Saint-Cyr military high school, using an anonymous self-administered questionnaire.Results. Among 669 adolescents (M/F sex-ratio, 2.3; mean age, 17 years [IC 95%, 15-20]), 40% had already had sex and 92% had used contraception. Boys and girls had a poor level of knowledge on infectious transmitted diseases. Regarding knowledge on HPV and cervical cancer, a better level was significantly associated with female gender (P = 10(-4)). In multivariate analysis, male gender, age under 18 years, lack of dialogue with parents on these subjects, low socioeconomic status of parents, and absence of health education were significantly associated with poor knowledge on these topics.Conclusion. These data should help healthcare providers better target access and content of sexual health education training. (C) 2013 Elsevier Masson SAS. All rights reserved.

What is the incidence of medical consultation for fecundity problems in the French population, taking into account pregnancy occurrence and resumption of contraceptive use?.Considering the occurrence of a pregnancy and resumption of use of contraception as competing risks, the cumulative incidence rate of medical consultation for fecundity problems was 9.0 [95 confidence interval (CI): 6.5; 11.9] after 12 months of unprotected intercourse and 12.2 [95 CI: 9.6; 15.3] after 24 months.Estimates of the prevalence of medical consultation due to involuntary infertility among couples who have sought a pregnancy for more than 12 months range from 25 to 50. Most of the studies however are limited by retrospective data collection, without considering the duration of time since the beginning of the period of unprotected intercourse (PUI) and without considering medical consultation for fecundity problems as a competing risk.This study is based on the Observatory of Fecundity in France survey, a population-based probability survey designed to estimate the frequency of involuntary infertility on a nationwide basis and to explore the associations with environmental factors. Women answered two telephone questionnaires, the first at the time of enrolment in 2007, the second at follow-up 1 year later. The current analysis was performed among a subsample of 6577 women recruited before or during a PUI and followed-up for 1 year.The study sample comprised 940 women aged 1844 years who had a PUI between the time of enrolment and the 1-year follow-up, and who had not consulted a physician for fecundity problems for the current PUI prior to enrolment. Women reported all the medical consultations they had because of difficulties becoming pregnant during the current PUI. The date of each consultation was carefully assessed. In France, women can consult a gynaecologist directly without referral by their general practitioner. The occurrence of a pregnancy and resumption of contraceptive use were considered as informative censoring events, using a competing risk model.Using the competing risk survival model, the cumulative incidence rate of first consultation was 9.0 [95 CI: 6.5; 11.9] 12 months after the start of the PUI and 12.2 [95 CI: 9.6; 15.3] after 24 months. The KaplanMeier method, which does not take competing risks into account, yielded substantially higher estimates: 26.0 [95 CI: 18.8; 32.5] at 12 months and 56.8 [95 CI: 44.2; 66.6] at 24 months. Among the 219 women who had attempted to become pregnant for at least 12 months, cumulative incidences of first medical consultations were 28.2 [18.738.9] 24 months after the start of the PUI, and 31.2 [21.3 42.4] after 36 months. The rates were higher among nulliparous but non-nulligravid women, followed by nulligravid women, as compared with parous women. Age was not strongly related to the occurrence of medical consultation.The main limitation of this study is the number of women lost to follow-up (29.7). In addition, results regarding the absence of an age effect should be taken with caution as few women in our study were aged over 35 years. Although such an attrition rate is commonly observed in prospective studies in the general population, it could have induced a selection bias that may have led to an underestimation of the rates of medical consultation. Sensitivity analyses, using the inverse probability weighting method suggest that our results are unlikely to be biased.This study reveals frequencies of medical consultation for fertility problems, which, after considering competing events such as pregnancy in a relevant statistical model, are lower than generally reported in the literature. The results also indicate the existence of a difference between the potential need and the actual use of medical care for fecundity problems. This suggests a need for studies to look for factors other than medical recommendations that may play a role in the patterns of medical seeking behaviours for fecundity problems, such as womens reproductive history, socio-economic characteristics or accessibility to infertility services.The study was funded by grants from ANR (French Agency for Research, SEST call on Environmental and Occupational Health), ANSES (French Agency for Food, environmental and Occupational Health Safety, EST call on Environmental and Occupational Health), InVS (French Institute for Public Health Surveillance). The team of Environmental Epidemiology applied to Fecundity and Reproduction has been funded by an AVENIR grant from Inserm (2007). Authors declare no conflict of interest.

Objective: 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 in metropolitan France and to describe the outbreak that occurred in 2010 and 2011.Methods: Criteria for report were those used for French national compulsory notification. The data, concerning active military personnel, were derived from epidemiological surveillance from 1992 to 2011 for the incidence rates and from notification forms completed in 2010 and 2011 by the military practitioners for the description of characteristics of cases.Results: Between January 1992 and July 2010, 833 cases of measles were reported. Since 2002, the mean incidence rate had been 1 case p. 100,000. A significant increase in incidence was observed in 2010 (10.1 p. 100,000) and in 2011 (41.4 p. 100,000). Clusters of cases accounted for 72.3% of cases. Rates were much higher among subjects under 30. Only 68.6% of cases had been previously vaccinated with at least one dose of MMR vaccine. The mean vaccine coverage among contacts of cases was approximated to 54.3%.Conclusions: The outbreak of measles observed in 2010 and 2011 in the French armed forces followed the same pattern as that observed nationally and at European level, and can be seen as the likely consequence of inadequate vaccination coverage. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Objective. - Evaluation of the efficacy and tolerability of highly crosslinked hyaluronic acid injections in treating the enophthalmous orbit.Methods. - Retrospective study of 11 enophthalmic patients who received an intraorbital injection of Juvederm (R) Voluma between June 2007 and October 2008. The mean follow-up was 19 months (range 12-25 months).Results. - Twelve orbits of 11 patients were treated, including nine with post-enucleation socket syndrome (PESS). Volume loss was corrected in 66.67% of cases (eight orbits) with only one intraorbital injection. Two patients requested an additional injection, achieving a final success rate of 83.33%. A rate of 16.67% (two orbits) developed some bruising, mild swelling and hypersensivity at the injection site within 24 hours of administration of the filler, representing minor, temporary side-effects of which the patients had been forewarned. Persistent edema was noted in 16.67% of cases, likely due to an overcorrection of ptosis, and ptosis was exacerbated in 16.67% of cases (two orbits). One ptosis was corrected after several months, with no particular difficulties related to the hyaluronic acid. No additional complications were identified.Conclusion. - Juvederm (R) Voluma appears to be an effective filler for reduction of enophthalmos with a single intraorbital injection. In our experience, this product seems to have a longer duration of action than reported by the manufacturer and appears to perform like a semipermanent or even permanent filler. (C) 2012 Elsevier Masson SAS. All rights reserved.

Dans le cadre de la pandémie grippale A (H1N1) pdm09, les armées ont mis en oeuvre un système inédit de surveillance épidémiologique à périodicité quotidienne. L’objectif de cette étude était d’évaluer l’apport de cette surveillance dans la gestion de la pandémie grippale aux différents niveaux décisionnaires du ministère de la défense. L’échantillon d’étude a été l’ensemble des conseillers santé des grands décideurs du ministère de la défense ainsi que les membres de la cellule de circonstance dédiée à la lutte contre la pandémie. Les données ont été jugées pertinentes, utiles et utilisées par une majorité des gestionnaires du risque pandémique. Grâce à ces informations, des actions concrètes ont pu être planifiées et mises en oeuvre. La surveillance quotidienne n’avait pas pour objet la santé publique mais l’estimation en temps réel de la disponibilité des forces armées. Pour les états-majors, l’épidémiologie médicale est un outil d’information indispensable pour la conduite des opérations.