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Article of November 7, 2006 of the DAILY NEWSPAPER DUMEDECIN,
French medical review Monitorings of the viral hemorrhagic fevers Progress in ten years Marburg or Ebola, these viruses responsible for viral hemorrhagic fevers (FHV) causes the worst feared.
The assessment published today in the ?weekly epidemiologic Bulletin? shows however that in forty years they made less victims than the hantavirus, the virus of the yellow fever or that of the dengue. Their monitoring improved thanks to earlier detection of the epidemic blazes. VIRUSES like Ebola or Marburg, discovered in 1967, have the reputation to be excessively contagious and to kill the majority of their victims.
?However, only 2439cas whose 1789d?c?s has been brought back for forty years, whereas the majority of the cases of viral hemorrhagic fevers is due to the hantavirus (2 million cases estimated per annum in the world, including more than 7.000 deaths), with the Lassa virus (350 000 cases estimated per annum, including 3.500 death in West Africa), with the virus of the yellow fever (200 000 cases per annum, including 4.000 death in Africa and South America) and with that of the dengue (500 000 estimated cases of hemorrhagic dengue per annum, including 12.000 death)?, explains Pierre Formenty, of the WHO (the World Health Organization), which makes this week a ten years assessment of monitoring of the FHV in the world.
This point, presented in the ?weekly epidemiologic Bulletin? (n? 43-44, of November 7, 2006), opens a series of articles on the threat which constitute the FHV, their control, the assumption of responsibility of the suspect cases locally or when it is about an imported case.
A syndromic approach.
The rise in the number of listed cases of FHV is probably due to a better detection, but reflects also a real increase in the number of epidemics related to the more frequent contacts of human with the animal tanks in the equatorial forests. Creation in 2000 of the network Goarn (Total Outbreak Alert and Response Network), world network of alarm and action in the event of epidemics, whose several networks are specific to the FHV, makes it possible from now on WHO to collect in real time of the reports/ratios or rumours on new blazes, to check information, to alert and coordinate the international assistance.
This network is dependent on the national programs of monitoring and, in the case of the FHV, WHO recommend a definition of the cases based on a syndromic approach (brutal fever + haemorrhage) without awaiting the precise identification of the causal agent. However, other viral diseases or bacterial (rickettsioses) or even certain intoxications (chemical, out-of-date or contaminated drugs) others that the FHV can be the cause of acute hemorrhagic fevers.
The episode to edge of a Cypriot ship off Guyana, in which a member of the crew is deceased of a complicated fever of a coma, confirms it. The ?BEH? recalls the stages of the assumption of responsibility which led suspicion of FHV (diagnosis eliminated thanks to the analyses carried out by the P4 laboratories from Lyon and P3 from the Pasteur institute from Cayenne) to the identification of Plasmodium falciparum. ?Essence is not to forget that the principal cause of fever with thrombop?nie remains paludism?, Pr Elisabeth Bouveret in its leading article comments on.
The infectiologist reports that, ?in the years 1980, the hospital Claude-Bernard was equipped with a ?bubble? of insulation for possible highly contagious patients. There was no confirmed case and the ?bubble? was removed because useless and dangerous for the care of the patients?.
Since, knowledge concerning the mode of transmission grew rich: it is about a transmission by exposure to blood and the precautions standards applied systematically in the hospitals of the developed countries are enough to avoid the transmission nosocomiale, like showed it the imported case of FHV the Congo-Crimea in Rennes in November 2004 (?the Daily newspaper? of April 19, 2005).
Remain, as the article of Pierre Tattevin, Arnaud Tarantola suggests it and Christian Michelet, that it seems imperative, to help the clinicians, to like work out specific, practical and realistic recommendations which take account of acquired knowledge, what was done for Sras or the avian flu.
Habits and traditions.
As for the question engraves immediate assumption of responsibility of the cases on the same spot of the epidemic, that of Marburg which touched Angola, most important ever described, which required the intervention of more than 20 organizations, showed the importance to take account of the habits and the local traditions, in particular not to make obstacle with the work of mourning of the families (preparation of the bodies, burials) and not to run the risk to cut population.
In short, the management of the epidemics improved during last years, even if progress remains to be made, in particular on collaboration with the programs of animal health and the models estimated. Vaccines and drugs to be used in postexposition against Ebola and Marburg are awaited soon.
Article of November 7, 2006 of the DAILY NEWSPAPER DUMEDECIN,
French medical review Monitorings of the viral hemorrhagic fevers Progress in ten years Marburg or Ebola, these viruses responsible for viral hemorrhagic fevers (FHV) causes the worst feared.
The assessment published today in the ?weekly epidemiologic Bulletin? shows however that in forty years they made less victims than the hantavirus, the virus of the yellow fever or that of the dengue. Their monitoring improved thanks to earlier detection of the epidemic blazes. VIRUSES like Ebola or Marburg, discovered in 1967, have the reputation to be excessively contagious and to kill the majority of their victims.
?However, only 2439cas whose 1789d?c?s has been brought back for forty years, whereas the majority of the cases of viral hemorrhagic fevers is due to the hantavirus (2 million cases estimated per annum in the world, including more than 7.000 deaths), with the Lassa virus (350 000 cases estimated per annum, including 3.500 death in West Africa), with the virus of the yellow fever (200 000 cases per annum, including 4.000 death in Africa and South America) and with that of the dengue (500 000 estimated cases of hemorrhagic dengue per annum, including 12.000 death)?, explains Pierre Formenty, of the WHO (the World Health Organization), which makes this week a ten years assessment of monitoring of the FHV in the world.
This point, presented in the ?weekly epidemiologic Bulletin? (n? 43-44, of November 7, 2006), opens a series of articles on the threat which constitute the FHV, their control, the assumption of responsibility of the suspect cases locally or when it is about an imported case.
A syndromic approach.
The rise in the number of listed cases of FHV is probably due to a better detection, but reflects also a real increase in the number of epidemics related to the more frequent contacts of human with the animal tanks in the equatorial forests. Creation in 2000 of the network Goarn (Total Outbreak Alert and Response Network), world network of alarm and action in the event of epidemics, whose several networks are specific to the FHV, makes it possible from now on WHO to collect in real time of the reports/ratios or rumours on new blazes, to check information, to alert and coordinate the international assistance.
This network is dependent on the national programs of monitoring and, in the case of the FHV, WHO recommend a definition of the cases based on a syndromic approach (brutal fever + haemorrhage) without awaiting the precise identification of the causal agent. However, other viral diseases or bacterial (rickettsioses) or even certain intoxications (chemical, out-of-date or contaminated drugs) others that the FHV can be the cause of acute hemorrhagic fevers.
The episode to edge of a Cypriot ship off Guyana, in which a member of the crew is deceased of a complicated fever of a coma, confirms it. The ?BEH? recalls the stages of the assumption of responsibility which led suspicion of FHV (diagnosis eliminated thanks to the analyses carried out by the P4 laboratories from Lyon and P3 from the Pasteur institute from Cayenne) to the identification of Plasmodium falciparum. ?Essence is not to forget that the principal cause of fever with thrombop?nie remains paludism?, Pr Elisabeth Bouveret in its leading article comments on.
The infectiologist reports that, ?in the years 1980, the hospital Claude-Bernard was equipped with a ?bubble? of insulation for possible highly contagious patients. There was no confirmed case and the ?bubble? was removed because useless and dangerous for the care of the patients?.
Since, knowledge concerning the mode of transmission grew rich: it is about a transmission by exposure to blood and the precautions standards applied systematically in the hospitals of the developed countries are enough to avoid the transmission nosocomiale, like showed it the imported case of FHV the Congo-Crimea in Rennes in November 2004 (?the Daily newspaper? of April 19, 2005).
Remain, as the article of Pierre Tattevin, Arnaud Tarantola suggests it and Christian Michelet, that it seems imperative, to help the clinicians, to like work out specific, practical and realistic recommendations which take account of acquired knowledge, what was done for Sras or the avian flu.
Habits and traditions.
As for the question engraves immediate assumption of responsibility of the cases on the same spot of the epidemic, that of Marburg which touched Angola, most important ever described, which required the intervention of more than 20 organizations, showed the importance to take account of the habits and the local traditions, in particular not to make obstacle with the work of mourning of the families (preparation of the bodies, burials) and not to run the risk to cut population.
In short, the management of the epidemics improved during last years, even if progress remains to be made, in particular on collaboration with the programs of animal health and the models estimated. Vaccines and drugs to be used in postexposition against Ebola and Marburg are awaited soon.
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