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Published on 27/12/2011

Infectious diseases

There is a wide variety of infectious diseases, as this group covers bacterial and viral infections, parasitoses and prion-induced diseases. There can be changes in the group due to the recurring emergence of new diseases such as the Severe Acute Respiratory Syndrome (SARS) in 2003, the AH1N1 pandemic flu of 2009 or the resurgence of diseases that had virtually disappeared, such as syphilis in the early 2000s.

InVS’s Department of Infectious Diseases focuses on infectious diseases that affect people's health because of their frequency, their ability to spread, their severity or because they affect populations that are particularly fragile or vulnerable. For most of these diseases under surveillance the Ministry in charge of Health has developed prevention or control measures to alleviate their impact on people's health, making them partly preventable. Such measures include emergency enforcement measures to limit the spread of the disease within the population, as well as multiannual public health programs focusing on information, prevention and care and treatment of populations that are at risk of catching or developing the severe forms of such diseases.

Acute gastroenteritis

As in all European countries, there is an epidemic of wintertime cases of acute gastroenteritis (AGE) every year in France. Thanks to data collected from the “Sentinelles” network it is estimated that every winter AGEs lead to between 1 million and 2.5 million visits to general practitioners. The increase in the number of visits for AGE can usually be observed between December and January, peaking most often during the first two weeks of January. During that peak the rate of visits due to AGEs is an estimated 300 to 600 visits per 100,000 people per week, but can be as high as 900 visits per 100,000 people per week as observed in January 2001.

Anthrax

Anthrax is a zoonosis caused by the bacterium Bacillus anthracis. Clinical symptoms in humans include cutaneous symptoms after coming into contact with contaminated animal products, digestive symptoms after ingesting contaminated meat, or pulmonary symptoms after inhaling contaminated aerosols (wool, leather, etc.). The last three cases reported in France date back to 1997. Anthrax is one of the diseases for which reporting is obligatory.

Blood donors

The purpose of this topic is to present InVS’s role in the French blood transfusion network, and more specifically in the blood donor surveillance network, as well as relevant efforts. It also aims to gather updated information on the epidemiological aspects of surveillance.

Botulism

Human botulism is a rare but potentially severe disease that is on the list of diseases that are subject to obligatory reporting. This topic includes a general introduction to the disease as well as a description of the surveillance mechanism implemented in France. Epidemiological data stemming from surveillance activities are presented. The topic includes practical information for health-care professionals who might wish to report suspicions of botulism, and also includes links to the websites of our main partners as well as links to other websites to flesh out the information provided. 

Bronchiolitis

Bronchiolitis is a young child's viral disease that chiefly affects children before the age of two. In a very large majority of cases the disease progresses favourably, either spontaneously or with the help of physiotherapy. In rare cases bronchiolitis requires a stay in the hospital in order to monitor respiratory functions and, if necessary, to implement resuscitative measures. Deaths caused by acute bronchiolitis are very rare (fewer than 1%).
Since July 2004 the French Institute for Public Health Surveillance (InVS) has set up a feedback information system based on data stemming from emergency services (the OSCOUR network, or Coordinated Emergency Department Surveillance Organization). The purpose of this system is to analyze the use of emergency services both quantitatively (number of patients) and qualitatively (medical reasons for using the service, patient's age, post-emergency referrals, etc.). The outcome of this exercise might lead to the setting-off of an alert.
Data is automatically transmitted to the InVS as a matter of routine based on information collected by hospital teams.
The data recorded includes age, gender, reasons for using the service, level of severity, medical diagnosis as well as the patient's referral once they leave the emergency service.
This surveillance system based on hospital emergencies complements the surveillance system of the Regional Groups for Influenza Surveillance (GROG). The GROG network helps to monitor the syncytial respiratory virus’s circulation by collecting the number of isolated SRV cases in France. The network also collects data on community medicine (general practitioners and paediatricians) regarding consultations for bronchiolitis among children under 2. Updated information is available on GROG’s website (www.grog.org).

Brucellosis

Brucellosis is a bacterial zoonosis caused by a bacterium of the type Brucella. It is chiefly transmitted by the ingestion of raw milk and products made with raw milk from contaminated animals. There is no human-to-human transmission. Its rate of incidence has dropped considerably since the 1930s thanks to infection control among ruminants (cattle, sheep, goats) and nearly all infections diagnosed today in France occur among people who have been contaminated while travelling abroad. Brucellosis surveillance is based on the compulsory reporting of the disease and on diagnoses carried out by the National Reference Center and its related laboratory. The purpose of this topic is to present a summary of brucellosis surveillance in France as well as studies carried out by the InVS and its partners.

Campylobacter

Together with Salmonella, Campylobacter is one of the most frequent causes of bacterial gastroenteritis in developed countries. This topic includes general background information on Campylobacter infections as well as a description of the monitoring mechanism that has been set up in France. The resulting epidemiological data is presented. This topic also includes links to the websites of our main partners.

Chicken pox

Chicken pox is a highly contagious viral disease that is mostly benign and primarily affects children. It is caused by a herpes virus (varicella zoster virus or VZV).
Every year there are approximately 700,000 cases of chicken pox (90% of those affected are under 10), 3,000 hospitalizations (75% of those affected are under 10) and 20 deaths (30% under 10). The data reflects how frequent and mostly benign the disease is, but also how it becomes more serious with age.
Chicken pox has been monitored by the Sentinel network since 1990 (www.sentiweb.org), a network run by the National Institute for Health and Medical Research (Inserm, Unit 707). Every week, the network's weekly newsletter reports the estimated number of cases of chicken pox that required a visit to a physician in metropolitan France, and also shows maps describing geographical breakdown.

Chikungunya

Chikungunya is an infectious disease caused by an insect-borne virus: the chikungunya virus. This virus of the Togaviridae family (alphavirus genus) was first isolated in Uganda in 1953 during an epidemic that occurred in East Africa. The term “chikungunya” means “that who walks bent over” in the Makonde language.

Cholera

Cholera is an acute digestive food-borne infection caused by ingesting water or food contaminated with the bacterium Vibrio cholerae belonging to serogroups 01 and 0139 (vibrio cholerae). It frequently results in epidemics in developing countries and circulates endemically in some South Asian countries. It can sometimes cause profuse but painless diarrhoea as well as vomiting that can rapidly lead to severe dehydration and to the subject's death in the absence of treatment.
In metropolitan France, cholera, which must be reported, is a rare imported condition of which there are fewer and fewer cases.

Collective food-borne infections

Collective food-borne infections (CFI) are defined as the occurrence of at least two similar cases, usually with gastrointestinal symptoms, and of which the cause can be connected to the same food-borne source.
In France, surveillance involves obligatory reporting since 1987 and is supplemented by data stemming from the National Reference Centre (CNR) for Salmonella.
Surveillance of CFIs helps to implement and evaluate measures aimed at preventing these events, thereby contributing to food safety.

Creutzfeldt-Jakob disease

Since 1992, an epidemiology surveillance network for the Creutzfeldt-Jakob disease (CJD) bringing together voluntary neurologists and neuropathologists under the coordination of Unit 360 (U360) at the National Institute for Health and Medical Research (Inserm) has been taking part in a European-wide study on the incidence and risk factors of this disease. Since 19 September 1996 suspicions of CJD and other human transmissible spongiform encephalopathies (TSE) are on the list of diseases that must be reported. Since that time, there has been close cooperation between the French Institute for Public Health Surveillance (InVS) and Inserm’s U708.
With regard to the emergence of the variant form of CJD (vCJD) and the expansion of potential data sources, in particular the use of research on protein 14-3-3 as a criterion for the presumption of CJD, InVS has strengthened surveillance of this disease since early 2000, together with various relevant partners. This has led to the creation of the National Network for the Surveillance of Creutzfeldt-Jakob and Related Diseases. The network is coordinated by InVS and was made formal by a three-year agreement between InVS and Inserm.

Dengue

Dengue is an insect-borne infectious disease caused by the dengue virus. This virus belongs to the Flaviridae family (flavivirus genus) and includes four different serotypes (DEN1 to DEN4). Dengue is transmitted from humans to humans by mosquitoes of the species Aedes.
Dengue is a disease that must be reported.

Diphtheria

Diphtheria is a highly contagious disease caused by Corynebacterium diphtheriae that spreads from humans to humans. Its most serious consequences stem from the toxin it secretes. The main symptom of the disease is tonsillitis or pharyngitis that can progress into cardiac or neurological impairments and lead to death. Transmission of diphtheria is airborne when in direct contact with infected individuals or healthy carriers. The toxin can also be secreted by Corynebacterium ulcerans and transmitted to humans through raw milk or pets, and by Corynebacterium pseudotuberculosis transmitted to humans through sheep.

Haemolytic uremic syndrome

Escherichia coli, which produce Shiga toxins, are responsible for a variety of clinical manifestations: regular or bloody diarrhoea, hemorrhagic colitis, haemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura.
Haemolytic uremic syndrome (HUS) affects young children in particular and is the main cause of kidney failure among children under 3.
This topic includes a general introduction to HUS as well as a description of the surveillance mechanism that exists in France. The epidemiological data stemming from the surveillance is presented. The topic includes practical information for health-care professionals who wish to report HUS cases and further suggests recommendations to prevent HUS among children under 15. There are also links to the websites of our main partners.

Hantavirus

Hantaviruses (Bunyaviridae family) are present on all continents and are responsible for hemorrhagic fevers with renal syndrome or cardiopulmonary syndrome. They are transmitted through rodents that, once infected, continue to be healthy carriers, making for an excellent virus reservoir. Human contamination generally occurs by inhaling dust contaminated by the waste products of infected animals, during forest activities or inside premises located close to a forest and which have been uninhabited for a long time.
Four types of hantavirus are in circulation on the European continent: Puumala, Tula, Dobrava-Belgrade and Saaremaa. They have similar features and seem to come from a common ancestor. Among humans, these viruses are responsible for hemorrhagic fever with renal syndrome (HFRS). In metropolitan France, FHSR is caused by the Puumala virus, first identified in the 1980s. The main reservoir is a forest rodent, the bank vole (Myodes glaerolus, formerly Clethrionomys glaerolus).
On the American continent and in several South American countries in particular other species of hantavirus are in circulation that are responsible for the hantavirus cardiopulmonary syndrome (HCPS). Rodents are the reservoir of such viruses that seem to be present in French Guiana.

Health-care associated infections

Health-care associated infections are those that occur during care and treatment of the patient or as patients are recovering. When they occur following a stay in the hospital the term used is nosocomial infections. Nosocomial infections are the most frequent complications of hospitalization; together with invasive procedures and medications they are the cause of serious unwanted events associated with the most frequent types of health-care.

The purpose of this topic is to make it easier to access surveillance data on health-care associated infections (HAI) in France. It includes updated information on various issues (surgical site infections, multi-resistant bacteria, intensive care infections, etc.) stemming from several surveillance systems or one-time studies coordinated by the French Institute for Public Health Surveillance, and close cooperation with a number of partners (CClin, Arlin, Cires, health-care facilities), under the aegis of national plans and programs outlined by the Ministry in charge of Health.

Hepatitis A

Acute hepatitis A occurs frequently in developing countries where it mostly affects children. In countries where sanitation and hygienic conditions are good and where the incidence is lower, hepatitis A occurs mostly among adults where it is most often symptomatic and severe.

For further information:

Hepatitis B

Hepatitis B is an infectious disease that affects the liver and is potentially severe due to the fact that it can shift to a chronic form in 2 to 10% of cases, with the risk of progressing to cirrhosis or liver cancer. Initial infection by the hepatitis B virus (HBV) is most often asymptomatic but in 0.1% to 1% of acute cases it can progress into fulminant hepatitis (a severe and lethal form of the disease in the absence of any liver transplant).

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Hepatitis C

With 170 million people affected by HCV throughout the world, 3 to 4 million people infected every year and with the potential to progress to a severe liver disease (cirrhosis, liver cancer), hepatitis C is a major public health issue.

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Hepatitis D

The virus responsible for hepatitis delta (HDV) is a small RNA virus of the Deltavirus genus. Its distinctive feature is to be a satellite virus of hepatitis B (HBV) of which it has the surface antigen. HDV could be acquired either together with HBV or as a secondary infection from a sick patient who is already carrying the virus. The epidemiology and mode of transmission of HDV are therefore based on those of HBV as the former can only be infectious in the presence of the latter.

Hepatitis E

Hepatitis E (HVE) is a zoonosis, i.e. a disease that is communicable from animals to humans.
Though humans are considered natural hosts of HVE the virus can nevertheless spread from contaminated animals (pigs, goats, cows, sheep, rodents) and the disease can be transmitted from animals to humans (zoonosis).
Data sources on hepatitis E exist in France but are limited. Hepatitis E is not a disease that occurs frequently. It can be diagnosed among people who have stayed in areas where hepatitis E is endemic (imported cases) but in most cases it is diagnosed among people who did not travel to areas where it is endemic (indigenous cases). Indigenous cases are more prevalent in the south of France, and the sources of contamination of such indigenous cases remain most often unexplained. Since 2002, the monitoring of hepatitis E is handled by the National Reference Center (CNR) for the hepatitis E virus.

For further information:

Herpes B (simian herpes, cercopithecine herpes virus 1, virus B, CHV1)

The simian herpes infection is a zoonosis that can be transmitted to humans by monkeys of the macaque genus. The disease is transmitted through the saliva of infected animals. The disease is frequent and benign among monkeys but extremely rare and severe among humans: if untreated, it is lethal in 80% of cases. Neurological sequelae can persist. Rapid treatment after contact with a contaminated monkey (bite, scratch, production of saliva or contact with biological samples) is therefore essential. If treatment is provided as early as possible following contact with a contaminated animal it can limit the disease's severity.
The simian herpes infection has so far never been diagnosed among humans in France, but contacts with monkeys that carry the virus have been reported, requiring medical care and treatment for people who have been exposed to the virus.

HIV and AIDS infections

The human immunodeficiency virus (HIV) is a human retrovirus that weakens the immune system of infected individuals. As the infection can remain asymptomatic for several years, only a serological test (which detects the presence of antibodies to HIV) will help to diagnose the infection. That person is then said to be HIV-positive.
The acquired immunodeficiency syndrome (AIDS) is the advanced stage of the HIV infection and corresponds to the appearance of an opportunistic infection due to the weakening of the immune system.
Thanks to combinations of antiretrovirals drugs since 1996 the life expectancy of people living with HIV has significantly increased.
HIV is transmitted sexually or through contact with infected blood. There is also what is known as vertical transmission, i.e. from the mother to her child. In France, HIV is mainly transmitted by the sexual route.
The purpose of this topic is to present a summary of data stemming from various surveillance systems for HIV/AIDS (such as obligatory reporting) and managed by the InVS. This information is available thanks to the involvement of biologists and practitioners who report the infection.

Invasive meningococcal infections

Meningococcal meningitis is a severe infection caused by the bacterium Neisseria meningitidis that leads to a swelling of the brain lining and of the spinal cord. Meningococcal meningitis is one of several invasive meningococcal infections. Its occurrence is rare in France but its severity resides in fatal prognosis (15% of cases). It chiefly affects children and teenagers and generally occurs between the beginning of the wintertime and the springtime. Different countries have different strains of the bacteria: serogroup A (mostly in Africa and Asia), B (the most frequent serogroup in France), C, and W135, which has been emerging over the past few years throughout the world. Other rarer serogroups have also been identified as pathogenic (X, Y, Z, etc.).
Meningococcal infections must be immediately reported to the Regional Health Agency (ARS), including cases of suspected infections. Reporting helps to implement measures aimed at preventing the appearance of secondary cases among the patient’s close contacts.

Seasonal influenza – Pandemic influenza

Influenza is a disease that occurs throughout the world. In Europe, it is responsible for wintertime seasonal epidemics involving the circulation of one or several strains of the Influenza virus. It can also appear as a worldwide epidemic called pandemic that occurs with the emergence of new type A influenza viruses, against which populations are not protected.
Influenza is monitored by various partners, while coordination is handled by the French National Institute for Public Health Surveillance.
Alongside the main section devoted to influenza, this topic also includes a section on the 2009-2010 pandemic, the H5N1 avian flu as well as influenza pandemics.

Legionellosis

Legionellosis is a pulmonary infection caused by the bacterium Legionella.
The bacterium Legionella is ubiquitous in the natural environment and thrives in artificial aquatic sites when all the conditions for its development are present, particularly between 25 and 45°C: hot water distribution networks, cooling towers, other facilities (whirlpools, spa bath therapy, landscape fountains, aerosols, etc.).
Contamination occurs through the respiratory route by inhaling aerosolized contaminated water. No human-to-human transmission has so far been demonstrated.
Legionellosis chiefly affects adults and is more prominent among people that have contributing factors: advanced age, tobacco use, chronic respiratory diseases, diabetes, immunosuppressive diseases, immunosuppressive treatments, alcoholism.
In most cases, with appropriate antibiotics (macrolid antibiotics or fluoroquinolones), the progression of the disease is favourable. The earlier the treatment is started, the more efficient the treatment will be.
In France, 1,540 cases were recorded in 2010, i.e. an incidence rate of 2.4 cases per 100,000 inhabitants.

Listeriosis

Listeriosis is a rare but serious disease caused by the bacterium Listeria monocytogenes.
It chiefly affects subjects whose immune system has been altered or is immature such as immune depressed individuals (in particular people suffering from cancer, liver diseases, people who have undergone transplants and people under hemodialysis), pregnant women, newborns, and elderly people.
There are approximately 300 cases of listeriosis diagnosed every year in France, i.e. a yearly incidence rate of 0.4 cases per 100,000 inhabitants.

Lyme’s disease

Caused by certain bacteria of the genus Borrelia, Lyme’s disease is transmitted by the bite of an infected tick. Roughly speaking, it progresses in three phases: erythema migrans at the site of the tick bite, disseminated infection, and tertiary phase. Its clinical expression differs widely from one patient to the other as the disease can start in any organ. Its progression can be transitional, recurring or chronic.

Malaria

Malaria is a parasitic infection caused by four species of Plasmodium and is transmitted by the bite of mosquitoes of the genus Anopheles. The département of Guiana and the departmental community of Mayotte are the only areas on the French territory where malaria is endemic. In metropolitan France, all cases of malaria are almost exclusively observed among people returning from countries where the transmission of malaria is active.
Malaria is one of the diseases that must be reported.

Measles

Measles is a highly contagious viral infection. Transmission is chiefly airborne. The virus is transmitted either directly in contact with an infected person, and sometimes indirectly due to the persistence of the virus in the air or on a contaminated surface through nasopharyngeal secretions.
Measles is being monitored by Inserm’s sentinel network (Unit 707) since 1985. The introduction of a dose of measles vaccine in the immunization schedule in 1983 followed by a second dose in 1997 cause the number of cases to gradually drop; based on data from the sentinel network (Inserm, Unit 707) there was an estimated 331,000 cases in 1996 and 4,448 in 2004. Due to lower viral circulation the network has simultaneously observed an increase in the average age at which the disease occurs, with the ratio of cases involving people over 10 increasing from 13% in 1985 to 62% in 2002. Because the sentinel network has reported fewer cases over the past years estimates have become inaccurate, with the risk of being unable to identify the virus’s active transmission area. As a result, as of 2005, measles has become one of the diseases that must be reported.

Non-typhoidal salmonellosis

Non-typhoid salmonellosis is an infectious disease caused by salmonella, infecting the digestive tract and causing mainly digestive disorders. This is distinct from typhoid and paratyphoid fevers caused respectively by Salmonella Typhi et Salmonella Paratyphi.
Salmonella is one of the main causes of food-based bacterial diseases in developed countries. The genus Salmonella (of the enterobacteria family) includes nearly 2,500 pathogenic serotypes for humans and animals. In France, 50 serotypes are responsible for 95% of human infections.
Infections appear as isolated cases, community epidemics, or as outbreaks of collective food-borne infections (defined as the occurrence of at least two grouped cases presenting similar symptoms, generally digestive symptoms, the cause of which can be connected to the same food-based source).

Surveillance of salmonellosis among humans is based on two systems for the collection of epidemiological data:

  • The National Reference Centre for Salmonella. This facility is involved in monitoring the disease by analyzing strains sent in by medical analysis laboratories and hospital laboratories, and by collecting information on strains for which the serotype has already been identified. This information helps to follow any changes in the number of isolated strains of Salmonella among humans and to detect epidemics. Concurrently, there are studies on the resistance to Salmonella antibiotics.
  • The obligatory reporting of collective food-borne infections (CFI). CFI outbreaks are defined as the occurrence of at least two grouped cases presenting similar symptoms, most often digestive symptoms, the cause of which can be connected to the same food-based source. All CFIs must be reported to the departmental health-care authorities (Departmental Directorate of Health and Social Affairs or the Departmental Directorate of Veterinary Services) by any individual (physician, head of family or head of facility) who noted the occurrence.

Pertussis

Pertussis is a bacterial infection (with little or no fever) of the lower respiratory tract that progresses slowly, but is highly contagious. Two bacteria of the genus Bordetella are responsible for the pertussis syndromes among humans: Bordetella pertussis and Bordetella parapertussis.
The number of cases of pertussis has significantly dropped since a vaccine was introduced. Nevertheless, the bacterium continues to circulate as the vaccine, like the disease, does not provide lifetime protection. Affected populations include newborns who are too young to be vaccinated as well as teenagers and adults who no longer benefit from the protection provided by the vaccine or the disease.
Transmission is airborne and occurs in contact with sick patients (coughing). It is chiefly transmitted within households or within communities. In all cases, an investigation must be carried out around sick patients in order to identify contaminants and secondary cases.
In France, pertussis surveillance is achieved through a network of voluntary paediatric hospital services called Renacoq, which operates in 42 facilities since 1996. Pertussis is not one of the diseases for which reporting is obligatory. However, the appearance of clusters of cases must be reported to the Regional Health Agency (ARS).

Plague

Plague is a zoonosis caused by the bacterium Yersinia pestis, discovered in 1894 by Alexandre Yersin.
The obligatory reporting of the disease should help to implement preventive measures at an early stage in the immediate vicinity of cases observed in order to limit the risk of other cases occurring. The three diseases that come under the International Health Regulations (plague, cholera, yellow fever) must be reported to the WHO.

Poliomyelitis

Poliomyelitis is an acute viral infection resulting from a poliovirus invading the gastrointestinal tract. This virus belongs to the genus enterovirus. Three types of this virus exist, namely serotypes 1, 2 and 3. It demonstrates strong affinity for the central nervous system with the risk of destroying motor neuron cell bodies at the anterior horn of the spinal cord. It is extremely stable and can remain viable in the environment for several weeks and sometimes even several months, depending on outside temperatures, level of humidity, sunshine, concentration of organic matter and the presence of aerobic bacteria.
The virus spreads from person to person, either directly (through the faecal-oral or respiratory route) or indirectly (by ingesting contaminated water or food). The only reservoir is humans.
In France, the reporting of poliomyelitis has been compulsory since 1936. Ever since immunization against poliomyelitis was introduced in the French immunization schedule (in 1958 for the Salk-Lépine inactivated vaccine and in 1962 for Sabin’s oral vaccine) and the fact that immunization became compulsory in July 1964, the number of cases rapidly dropped (figure 2). The last case of indigenous poliomyelitis dates back to 1989 and the last imported case was reported in 1995. Both cases involved adults and the last isolation of a field poliovirus in an individual that had not travelled recently also dates back to 1989.
Extreme vigilance is required against the potential reintroduction of a poliovirus due to the persistence of endemic areas throughout the world.

Severe acute respiratory syndrome

The SARS pandemic of 2003 in Asia spread rapidly to thirty countries before coming to a halt in three months’ time thanks to drastic prevention and control measures. In France, the response implemented as soon as the international alert was triggered included epidemiological surveillance centralized at the InVS. Any potential case of SARS must be reported to the InVS and that person must be placed in strict isolation. Medical and epidemiological surveillance helps to determine whether it is a probable case or whether it can be ruled out. Individuals in contact with probable cases are placed in quarantine for 10 days in their homes and monitored on a daily basis.
Overall, 437 possible cases were reported between March and July 2003. Seven probable cases were identified (including one casualty), and 77 contacts were followed up. No secondary transmissions were identified.

Rabies

Rabies is a zoonosis that can be transmitted to humans and which affects the central nervous system. The disease is transmitted by the saliva of an infected animal. Once the disease begins it is fatal for humans. Early treatment following the contaminated contact (bite, scratch, licking of inflamed skin or mucous membrane) is therefore necessary.
Terrestrial rabies (as opposed to bat rabies) has been eliminated from the French territory. Nevertheless, there are still risks of rabies affecting humans through bites suffered in a foreign country, by an illegally imported rabid animal or by a rabies-carrying bat.
Surveillance of human rabies (indigenous or imported) is handled by the French Institute for Public Health Surveillance, together with the Institut Pasteur. The National Reference Center for Rabies at the Institut Pasteur is the only entity able to define cases of human rabies. Cases of suspicion of human rabies are sent in by hospital centres and are analyzed using biological techniques (immunofluorescence, Elisa, cell culture inoculation, PCR). It also diagnoses animals suspected of being the source of human contamination, i.e. animals that show symptoms indicative of rabies and which have bitten or scratched humans. Surveillance of animals not suspected of human contamination is handled by the French Food Safety Agency (Afssa) at the Research Laboratory for Rabies and Wild Animal Pathology.

Resistance to anti-infectious agents

Inappropriate use of antibiotics contributes to the development of bacterial resistance to antibiotics. The development of such resistance results in reduced therapeutic arsenals for some patients as well as the possibility of eventually being faced with therapeutic dead ends. Resistance to antibiotics has become a major public health issue.
In the early 2000s making data on antibiotics resistance available was identified as one of the target actions of the National Plan for Antibiotic Efficacy.
In France, surveillance of bacterial resistance to antibiotics relies on many surveillance partners and networks, the coordination of which is handled by the French Institute for Public Health Surveillance (InVS). Focusing on bacteria/antibiotic pairs that are of interest to human health, surveillance is based on voluntary participation of laboratories in health-care facilities or in cities.
The purpose of this topic is to make it easier to access surveillance data on resistance to antibiotics in France. It includes updated information on the progression of resistance to anti-infectious agents in terms of human health, which has been collected on a permanent basis or at certain times at national and regional level. We have also included some elements of surveillance on antifungal resistance.

Rubella

Rubella is a generally benign disease but a viral infection during the first few months of pregnancy can cause foetal deaths or congenital malformation rubella (selectively affecting the eyes, hearing mechanism, circulatory system and central nervous system).
With a view to eliminating congenital rubella in France the rubella vaccine was introduced for young girls as early as 1970, then in the immunization schedule of newborns in 1983 together with the measles vaccine, and three years later with the mumps vaccine (triple vaccine). In 2005, as part of the 2005-2010 plan to eliminate measles and congenital rubella in France, new vaccine measures were recommended, including triple immunization catch-up campaigns for all people born after 1980. These measures are expected to increase the immunization coverage for rubella among women of childbearing age.
Surveillance to identify cases of rubella infections that occurred among pregnant women and cases of congenital rubella among newborns was implemented in France in 1976 through the Renarub network. The purpose of the network is to evaluate the impact of the immunization policy as well as progress made towards eliminating congenital rubella.

Tetanus

Tetanus is an acute infection caused by exotoxins produced by a Gram-positive anaerobic bacillum, Clostridium tetani. This bacterium is ubiquitous and lives in the digestive tract of animals. It survives in animal waste matter and in the ground in an extremely resistant sporulated form. It enters the organism through a cutaneous wound. When anaerobic (absence of oxygen) conditions are present spores germinate and toxins are produced at the site of the wound. As the toxins are disseminated in the general blood circulation they interfere with neurotransmitters and after an incubation period of 4 to 21 days this will lead to neuromuscular effects with contractions, muscle spasms and convulsions.
To prevent this disease there has been a vaccine for more than 60 years whose efficiency and safety are almost perfect. In France, it is part of the required vaccines since 1952.
However, due to a boost immunization policy among adults that is not always properly implemented the disease has not been entirely eradicated. Although the number of annual cases of tetanus remains low (fewer than 20 reported cases on an annual basis over the past 10 years, i.e. a yearly average incidence rate of 0.30 cases for every 1 million inhabitants over that period of time) this infection is still a severe disease that requires prolonged hospitalization in an intensive care unit and can cause sequelae with high ratios of lethality (on average, 23% of individuals affected will die).
The surveillance data of tetanus cases reveals the following epidemiological features: the disease always affects the highest age brackets of the population (between 2000 and 2009, 75% of the 175 reported cases were aged 70 and above) and mostly affects women (73%), who are not as well protected as men as the latter were revaccinated during their military service (that is, as long as military service was compulsory). In a majority of cases (approximately 75%) the entry point is a minor wound with which soil or plant debris have come into contact, but the share of chronic wounds plays no small part (between 10 and 15%); it should also be noted that in approximately 10 to 15% of cases the entry point can go completely unnoticed.

Tuberculosis

Tuberculosis is a disease caused by a bacillus (mycobacteria of the tuberculosis complex) that usually attacks the lungs and spreads through the air. Rapidly identifying cases of tuberculosis and providing appropriate care and treatment are the most important elements of tuberculosis control, as they help to limit the spread of the infection to the community while preventing the development of resistance to anti-tuberculosis drugs. Surveillance of tuberculosis is chiefly based on obligatory reporting. The purpose of this topic is to provide information on tuberculosis surveillance (methods, results) and on tuberculosis control in France.

Tularaemia

Tularaemia is a zoonosis caused by the infection by the bacterium Francisella tularensis. The bacterium's reservoir includes wild rodents (voles, field mice, etc.) and ticks (Ixodes). Hares and ticks are the main vectors of human infection. Domestic animals such as sheep, cats and dogs are accidental hosts but can be the cause of human infection.
Since 2002, tularaemia is on the list of diseases that must be reported.

Typhoid and paratyphoid fevers

Infections caused by Salmonella Typhi (typhoid fever) and by Salmonella Paratyphi A, B and C (paratyphoid fevers) are systemic infections that originate in the digestive system.
These illnesses occur throughout the world and are endemic in developing countries characterized by poor hygiene and sanitation (Asia, Africa, South America). They are rare and mostly sporadic in metropolitan France and most cases are imported following a trip to a country where the infection is endemic.
Prophylaxis requires personal hygiene and food hygiene, avoiding eating raw food and drinking water that might be contaminated, especially in countries where the illness is endemic. Typhoid and paratyphoid fevers are also called “dirty hands diseases” as the disease’s chain of transmission can be interrupted by carefully washing one's hands after any contact with faeces and before handling any food.
There is a vaccine against typhoid fever that is recommended for anyone (as of two years old) travelling to an endemic area.
Typhoid and paratyphoid fevers are diseases that must be reported.

West Nile Virus

In France, following the West Nile virus (WNV) infections that cause an epidemic among humans (13 cases) and horses in the region of Camargue between 1962 and 1965 not a single case had been detected among humans or horses up until the year 2000. In the summer of that year 76 cases of equine encephalitis caused by WNV were identified in Camargue, but there were no severe symptomatic human cases.
In 2001, following this equine epidemic, stronger surveillance was implemented on the four aspects of the virus’s epidemiological cycle (entomological, avian, equine and human) in order to identify any circulation of the WNV at an early stage and to rapidly put control measures into place.
This multidisciplinary surveillance is activated every year between 1 June and 31 October. It was initially implemented in 2001 in three départements of the Camargue region (Bouches-du-Rhône, Gard, Hérault) and was later extended to Corsica in 2002, then in 2003 to the Mediterranean basin (Pyrénées-Orientales, Aude, Var, Alpes-Maritimes, Alpes-de-Haute-Provence) after human and equine cases were identified in the Var département. Coordination is handled by the General Directorate for Health and the General Directorate of Food, with help from the French Institute for Public Health Surveillance (InVS) and Interregional Epidemiology Units (Cire), Regional Health Agencies, the CNR in charge of insect-borne viruses and its related laboratory, Afsaa’s National Reference Laboratory, the Departmental Directorates of Veterinary Services, the EID and ONCFS.

Yellow fever

Yellow fever is an arboviral disease that affects sub-Saharan Africa (with the exclusion of Southern Africa) and South America. It causes an acute viral infection with varying levels of severity, from non-apparent or attenuated forms to the peracute form which can rapidly lead to death. An effective vaccine is available and is compulsory for people travelling in certain countries or territories (including the département of Guiana).
In France, yellow fever is one of the diseases that must be reported. No cases have been reported in metropolitan France since 1978.



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