Re: Un malade sur 1 000 peut faire une forme grave
Re: Un malade sur 1 000 peut faire une forme grave
HEALTH a patient on 1 000 can make a serious form [ February 23, 2006 ] http://www.newswithviews.com/Ryter/jon123.htm The epidemic which prevails with the Meeting will have had at least a merit: to reveal that the chikungunya is not only one minor illness, but can cause serious forms and result in death, more or less directly. Extremely fortunately, these serious forms, for tragedies which they are, taken individually, are with the first glance rather very few: for 1 000 declared cases, according to the elements collected until today. It is much and at the same time little if one compares with other viruses. the article of died of the day at the following day a new old virus of more than two centuries Change, vaccine and drug Mortal, the virus of the chikungunya was on several occasions already, indirectly but also directly. The last official assessment of the epidemic, on February 12, evokes 52 certificates of death where the chikungunya appears. In five of them the virus would have even played a direct part in the death to believe the medical authorities of them r?unionnaises. Vis-a-vis for this around fifty of death, it is also necessary to put in parallel an almost identical number of serious forms which were declared among patients r?unionnais since the beginning of the epidemic. The first cases go up in June and in each one of them a vital function had to be compensates by the intensive care units of the GHSR of Saint-Pierre or the CHD of Saint-Denis. For the owner of the urgencies of this last establishment, there are no doubts "all the patients who were intub?s and ventilated in reanimation would not be there any more without that". All things considered, "the number of deaths was undervalued by the means of care which one has here with the Meeting, I think that there was probably around fifty of serious forms", continues Dr. Bernard Ga?z?re. The LETHALITY OF the VIRUS Consequently, it appears reasonable to count on a hundred serious forms on the whole of the island since the beginning of the epidemic: between the patients who left reanimation with more or less of after-effects and those which died more or less directly of the chikungunya. A rapid calculation thus gives, according to the official figures at last 12 February, a theoretical ratio of 1 serious form for 1 000 infected people. "I think that that must range between 0,5 and 1 per 1 000 under condition of course that there were really only 110 000 cases and that I doubt it a little, I believe that it is rather a low fork", Dr. Ga?z?re recognizes. It is true that the number of the asymptomatic forms of the chikungunya remains still an unknown factor. Perhaps for the 110 000 declared cases, it is necessary to add a significant number of operational carriers (30 % or more) which while having been in contact with the virus did not develop clinical signs. The theoretical ratio of 0,1 % remains nevertheless quite distant from that of other pathologies much more dangerous for the man. If the chikungunya seems to you particularly aggressive, that to say then SARS (acute respiratory syndrome) and more still of the aviary influenza "which kills once on two", Dr. Ga?z?re underlines. He also recalls that "until in the Sixties with the Meeting, paludism was responsible for the third of the deaths, that is to say 3 000 died per annum". Finally, the aggressiveness of the virus seems to be comparable with certain forms of dengue, but that remains to be confirmed on the long term. By way of comparison, at the time of the epidemic of dengue, 2003 in Martinique, "there had been twenty died for 22 000 cases", said the chief of the urgencies of Denis Saint. A serious form for thousand or 0,1 %, in the case of the chikungunya, that can seem enormous, very likewise, especially for a disease qualified until at the beginning of the year like only benign. Little documented, this disease, presents up to that point only in countries in the process of development, striking for the first time an area of the world equipped, no matter what one says some, of medical infrastructures of point. They only made it possible to carry out investigations which revealed the lethality of the virus. "At the beginning, there was really few information. And, nasty surprise, one saw appearing new forms which were not described in the medical literature. These emergent forms, one sees them today with the Meeting, but they could very well exist before in Africa ". With the notable difference that the ascribable deaths with the chikungunya passed there unperceived in the absence of sufficient medical means. ONE STARTS TO KNOW They were certainly allotted to one or the other many diseases who strike these areas, like paludism or the dengue. The only mention of a former serious form, Dr. Ga?z?re found "in a study going back to 1971 when French doctors had diagnosed in Kampuchea a neurological attack in a child, but it was right two lines and half". If, at the beginning of the epidemic with the Meeting, "one would have better done to say than one did not know", as the chief of the urgencies of the CHD thinks it, today one starts to know. Several types of serious forms of the chikungunya in the adult start to be seriously documented. These serious forms are accompanied by complications with neurological and hepatic attacks. Concerning the neurological attacks, the virus seems to have a certain predilection for the sphere m?ningo-cephalgia, a tropism as say the doctors. Dr. Ga?z?re for this reason evokes a first case last June at a 75 year old man. The results of the taking away confirmed that the chikungunya was at the origin of its neurological problems whereas at the beginning, they had been charged to a possible herpes, known him to cause enc?phalites with often very important after-effects. A similar scenario was represented the next month but this time concerning a 24 year old young woman who was before that in perfect health. Cases which unfortunately did not prove to be single. Others appeared in Saint-Pierre as with the CHD of Saint-Denis, as well in children as of the adults. They are detailed in the information memorandum carried out by the intensive care units of the CHD and of the GHSR which is used for sensitizing of the doctors r?unionnais. Until last 9 February, the GHSR treated in reanimation "four enc?phalites with chikungunya" on old patients from 45 to 64 years and which presented certain factors of risk (diabetes or alcohol). Only one presented then after-effects, "severe episodes of confusion". During the same time, an identical number of cases was taken charges some with the CHD. There, the patients were old enters 24 and 82 years, without there being "notable factors of risks" and three of them underwent "moderate" after-effects. SERIOUS HEPATITISES the doctors of the intensive care units were also confronted with "serious hepatitises in alcoholics or sick people of the liver", specifies Dr. Ga?z?re. Factors of risk which are included in the reference document of the urgentists r?unionnais. These serious forms, of which the imputability with the chikungunya remains to be affirmed completely, required all the same "two transfers in metropolis for Clerc's Office". The alcoholics and the patients of the liver touched by the chikungunya must particularly be vigilant with regard to paracetamol. If there remains an excellent analgesics, its negative impact on the liver is known for a long time if one "forces" the amount. The head of department of the CHD of Saint-Denis evokes also his "doubts about attacks of the c?ur related to the chikungunya, especially in the child". For the hour, no case in the adult was officially announced by the medical environment, but of the cardiac consequences of the infection remain possible. Moreover, the medical literature makes state of two cases of myocarditides. The wards of the island have, moreover, of serious suspicions on two other cases, currently examined with the Meeting, of inflammatory attack of the cardiac muscle in bond with the chikungunya. It is also necessary to add to all that, other serious septic forms which can touch any body. Without finally forgetting renal attacks which required for several patients the placement under dialysis. But, in these cases, it is not so much the virus itself which would be in question, but more dehydration due to the fever and of the complications relating to the treatment itself with aspirin for example. File carried out by Pierre Leyral A virus, two stocks the chikungunya is an arbovirus of group A (Alphavirus) of the family of Togaviradae. One distinguishes, from their biological characteristics, two stocks different from the virus: an Asian stock and a African stock. It is probably the latter which caused the epidemic which currently strikes Reunion and several other islands of the Indian Ocean. In same time, the data base of the Pasteur Institute on the African viruses evokes 418 stocks different identified from this alphavirus. WHO interferes "the chikungunya is seldom mortal". This assertion does not come from no matter whom but from the very official World Health Organization (WHO), which must send researchers besides to R?union. These experts of the regional office of Africa (AFRO) and the head office of WHO will be missionn?s "to evaluate measurements of fight taken up to that point: activities of anti-vectorial fight, medical education campaign of great scale in the media to sensitize the population with to be taken and the reinforcement protection measures of the epidemiologic and vectorial monitoring ", can one read in the official statement of WHO. The latter is concerned with situation r?unionnaise, but also risks for the whole of the zone. Moreover "the team will study with the national teams a sous-r?gionale strategy of monitoring and of fight against the chikungunya and others arboviroses", for that "she will go to Reunion, Madagascar, Maurice and will coordinate his visit in Seychelles with the mission of antivectorielle fight of AFRO".
Re: Un malade sur 1 000 peut faire une forme grave
HEALTH a patient on 1 000 can make a serious form [ February 23, 2006 ] http://www.newswithviews.com/Ryter/jon123.htm The epidemic which prevails with the Meeting will have had at least a merit: to reveal that the chikungunya is not only one minor illness, but can cause serious forms and result in death, more or less directly. Extremely fortunately, these serious forms, for tragedies which they are, taken individually, are with the first glance rather very few: for 1 000 declared cases, according to the elements collected until today. It is much and at the same time little if one compares with other viruses. the article of died of the day at the following day a new old virus of more than two centuries Change, vaccine and drug Mortal, the virus of the chikungunya was on several occasions already, indirectly but also directly. The last official assessment of the epidemic, on February 12, evokes 52 certificates of death where the chikungunya appears. In five of them the virus would have even played a direct part in the death to believe the medical authorities of them r?unionnaises. Vis-a-vis for this around fifty of death, it is also necessary to put in parallel an almost identical number of serious forms which were declared among patients r?unionnais since the beginning of the epidemic. The first cases go up in June and in each one of them a vital function had to be compensates by the intensive care units of the GHSR of Saint-Pierre or the CHD of Saint-Denis. For the owner of the urgencies of this last establishment, there are no doubts "all the patients who were intub?s and ventilated in reanimation would not be there any more without that". All things considered, "the number of deaths was undervalued by the means of care which one has here with the Meeting, I think that there was probably around fifty of serious forms", continues Dr. Bernard Ga?z?re. The LETHALITY OF the VIRUS Consequently, it appears reasonable to count on a hundred serious forms on the whole of the island since the beginning of the epidemic: between the patients who left reanimation with more or less of after-effects and those which died more or less directly of the chikungunya. A rapid calculation thus gives, according to the official figures at last 12 February, a theoretical ratio of 1 serious form for 1 000 infected people. "I think that that must range between 0,5 and 1 per 1 000 under condition of course that there were really only 110 000 cases and that I doubt it a little, I believe that it is rather a low fork", Dr. Ga?z?re recognizes. It is true that the number of the asymptomatic forms of the chikungunya remains still an unknown factor. Perhaps for the 110 000 declared cases, it is necessary to add a significant number of operational carriers (30 % or more) which while having been in contact with the virus did not develop clinical signs. The theoretical ratio of 0,1 % remains nevertheless quite distant from that of other pathologies much more dangerous for the man. If the chikungunya seems to you particularly aggressive, that to say then SARS (acute respiratory syndrome) and more still of the aviary influenza "which kills once on two", Dr. Ga?z?re underlines. He also recalls that "until in the Sixties with the Meeting, paludism was responsible for the third of the deaths, that is to say 3 000 died per annum". Finally, the aggressiveness of the virus seems to be comparable with certain forms of dengue, but that remains to be confirmed on the long term. By way of comparison, at the time of the epidemic of dengue, 2003 in Martinique, "there had been twenty died for 22 000 cases", said the chief of the urgencies of Denis Saint. A serious form for thousand or 0,1 %, in the case of the chikungunya, that can seem enormous, very likewise, especially for a disease qualified until at the beginning of the year like only benign. Little documented, this disease, presents up to that point only in countries in the process of development, striking for the first time an area of the world equipped, no matter what one says some, of medical infrastructures of point. They only made it possible to carry out investigations which revealed the lethality of the virus. "At the beginning, there was really few information. And, nasty surprise, one saw appearing new forms which were not described in the medical literature. These emergent forms, one sees them today with the Meeting, but they could very well exist before in Africa ". With the notable difference that the ascribable deaths with the chikungunya passed there unperceived in the absence of sufficient medical means. ONE STARTS TO KNOW They were certainly allotted to one or the other many diseases who strike these areas, like paludism or the dengue. The only mention of a former serious form, Dr. Ga?z?re found "in a study going back to 1971 when French doctors had diagnosed in Kampuchea a neurological attack in a child, but it was right two lines and half". If, at the beginning of the epidemic with the Meeting, "one would have better done to say than one did not know", as the chief of the urgencies of the CHD thinks it, today one starts to know. Several types of serious forms of the chikungunya in the adult start to be seriously documented. These serious forms are accompanied by complications with neurological and hepatic attacks. Concerning the neurological attacks, the virus seems to have a certain predilection for the sphere m?ningo-cephalgia, a tropism as say the doctors. Dr. Ga?z?re for this reason evokes a first case last June at a 75 year old man. The results of the taking away confirmed that the chikungunya was at the origin of its neurological problems whereas at the beginning, they had been charged to a possible herpes, known him to cause enc?phalites with often very important after-effects. A similar scenario was represented the next month but this time concerning a 24 year old young woman who was before that in perfect health. Cases which unfortunately did not prove to be single. Others appeared in Saint-Pierre as with the CHD of Saint-Denis, as well in children as of the adults. They are detailed in the information memorandum carried out by the intensive care units of the CHD and of the GHSR which is used for sensitizing of the doctors r?unionnais. Until last 9 February, the GHSR treated in reanimation "four enc?phalites with chikungunya" on old patients from 45 to 64 years and which presented certain factors of risk (diabetes or alcohol). Only one presented then after-effects, "severe episodes of confusion". During the same time, an identical number of cases was taken charges some with the CHD. There, the patients were old enters 24 and 82 years, without there being "notable factors of risks" and three of them underwent "moderate" after-effects. SERIOUS HEPATITISES the doctors of the intensive care units were also confronted with "serious hepatitises in alcoholics or sick people of the liver", specifies Dr. Ga?z?re. Factors of risk which are included in the reference document of the urgentists r?unionnais. These serious forms, of which the imputability with the chikungunya remains to be affirmed completely, required all the same "two transfers in metropolis for Clerc's Office". The alcoholics and the patients of the liver touched by the chikungunya must particularly be vigilant with regard to paracetamol. If there remains an excellent analgesics, its negative impact on the liver is known for a long time if one "forces" the amount. The head of department of the CHD of Saint-Denis evokes also his "doubts about attacks of the c?ur related to the chikungunya, especially in the child". For the hour, no case in the adult was officially announced by the medical environment, but of the cardiac consequences of the infection remain possible. Moreover, the medical literature makes state of two cases of myocarditides. The wards of the island have, moreover, of serious suspicions on two other cases, currently examined with the Meeting, of inflammatory attack of the cardiac muscle in bond with the chikungunya. It is also necessary to add to all that, other serious septic forms which can touch any body. Without finally forgetting renal attacks which required for several patients the placement under dialysis. But, in these cases, it is not so much the virus itself which would be in question, but more dehydration due to the fever and of the complications relating to the treatment itself with aspirin for example. File carried out by Pierre Leyral A virus, two stocks the chikungunya is an arbovirus of group A (Alphavirus) of the family of Togaviradae. One distinguishes, from their biological characteristics, two stocks different from the virus: an Asian stock and a African stock. It is probably the latter which caused the epidemic which currently strikes Reunion and several other islands of the Indian Ocean. In same time, the data base of the Pasteur Institute on the African viruses evokes 418 stocks different identified from this alphavirus. WHO interferes "the chikungunya is seldom mortal". This assertion does not come from no matter whom but from the very official World Health Organization (WHO), which must send researchers besides to R?union. These experts of the regional office of Africa (AFRO) and the head office of WHO will be missionn?s "to evaluate measurements of fight taken up to that point: activities of anti-vectorial fight, medical education campaign of great scale in the media to sensitize the population with to be taken and the reinforcement protection measures of the epidemiologic and vectorial monitoring ", can one read in the official statement of WHO. The latter is concerned with situation r?unionnaise, but also risks for the whole of the zone. Moreover "the team will study with the national teams a sous-r?gionale strategy of monitoring and of fight against the chikungunya and others arboviroses", for that "she will go to Reunion, Madagascar, Maurice and will coordinate his visit in Seychelles with the mission of antivectorielle fight of AFRO".
