Neurological manifestations of Zika virus infection

Zika virus (ZIKV) is a flavivirus (Flaviviridae family) transmitted mainly by Aedes mosquitoes. The virus was restricted to the African continent until its spread to south-east Asia in the 1980’s, the Micronesia in 2007, the French Polynesia in 2013 and, more recently in the Americas in 2015, where, up to date, the World Health Organization (WHO) has estimated about 3-4 million total cases of ZIKV infection. During outbreaks in the French Polynesia and Brazil in 2013 and 2015, respectively, national health authorities reported potential neurological complications of ZIKV disease, chiefly an upsurge in Guillain-Barré syndrome, which coincided with ZIKV outbreaks. On the other hand, the emergence of ZIKV in Brazil has been associated with a striking increase in the number of reported cases of microcephaly in fetus and newborns, twenty times higher than in that reported in previous years. While investigations are currently assessing whether there is an actual association between neurological complications and ZIKV infections, the evidence was enough worrisome for WHO to declare a public health emergency of international concern. Here we present an updated review addressing what is currently known about the possible association between ZIKV infection and the development of severe neurological disorders.     

The absence of Sindbis virus from French Polynesia]

The authors report, in French Polynesia that Sindbis antigen is a good control for rubella serodiagnosis. Data are presented on Hemagglutination Inhibition from 2,032 sera, showing no evidence of any Sindbis antigen circulation.     

Evaluation of larvicide susceptibility of Culicidae in French Polynesia

Larval tests on 4th-stage Aedes aegypti, Aedes polynesiensis and Culex quinquefasciatus of French Polynesia, according to the WHO method, demonstrate susceptibility of these species to organophosphorous compounds and less susceptibility to insect growth regulators.     

Leprosy in the French Polynesian archipelagoes from 1967 to 1987

Between 1967 and 1987, 255 new cases of leprosy were detected in French Polynesia (FP) that means on average a 8.6% detection rate. Average detection rate calculated in 7 three-year periods did not vary significantly during the 21 years studied period of time. In two remote archipelagoes of FP average detection rate of leprosy is specially high: Gambier archipelago and Southern Marquesas archipelago with respectively a 54.7 and a 48.9% detection rate. To control leprosy, the network of treatment and active case-finding should be strengthened in archipelagoes and chemoprophylaxis programmes could be planned in places where the problem is especially important.     

Chromosomal DNA fingerprinting analysis using the insertion sequence IS6110 and the repetitive element DR as strain-specific markers for epidemiological study of tuberculosis in French Polynesia.

The polymorphism of Mycobacterium tuberculosis strains was evaluated in French Polynesia, an area with a low incidence of tuberculosis and a population which has been geographically stable during recent decades. Nonrepetitive strains isolated from 64 patients during 1991 and 1992 were subjected to DNA restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 and the repetitive element DR as probes. Thirty-eight different IS6110 RFLP types were identified. They could be clustered in 11 groups. All the members of each group are identical or differ by one to three bands. All the other strains are gathered in the miscellaneous group. In some cases, transmission of strains with identical RFLP types between patients of the same family or between patients living in the same area was identified. Strains exhibiting similar IS6110 RFLP types also exhibited identical DR RFLP patterns, confirming that strains with similar types were genetically linked. Strains belonging to two different IS6110 clusters exhibited the same DR RFLP type. These data may also indicate a common origin for these strains and evolution to new IS6110 types. The results obtained in this study suggest that not only reactivation of latent tuberculous infections but also active transmissions are still occurring in French Polynesia.     

An updated review of Zika virus

The current outbreak of Zika virus (ZIKV) in South America is one of the most serious public health emergencies since the Ebola outbreak of West Africa [2014]. ZIKV belongs to the flaviviridae family and has two lineages (Asian and African). The virus was first discovered in Uganda [1947] and the first human infection was identified in Nigeria [1952]. The current epidemic is the third of its type after that of Yap Island, Micronesia [2007] and French Polynesia [2013]. Phylogenetic studies revealed that the current strain shares about 99.7% of nucleotides and 99.9% of amino acids with the strain of French Polynesia epidemic [2013], suggesting that it has spread across the Pacific Ocean to invade South America. Aedes Aegypti mosquito is the main vector for ZIKV and there are some reports describing possible sexual and maternal to fetal transmission. ZIKV infection is known to be self-limited. However, recent reports suggested that it can be associated with neurological manifestations as Guillan-Barrè Syndrome and microcephaly in the newborn population. Currently, vector control seems to be the most effective available preventive measure against ZIKV spread. The development of broad spectrum antivirals and ZIKV vaccines should be a priority of future research.     

Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group]

Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.     

Epidemiology of Nontuberculous Mycobacteria in French Polynesia

As few data are available in the Pacific countries and territories of the Oceania region regarding nontuberculous mycobacteria, we retrospectively identified 87 such isolates from French Polynesia from 2008 to 2013 by hybridization using DNA-strip, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and partial rpoB gene sequencing. Partial rpoB gene sequencing classified 42/87 (48.3%) isolates in the Mycobacterium fortuitum complex, 28 (32.2%) in the Mycobacterium abscessus complex, 8 (9.2%) in the Mycobacterium mucogenicum complex, and 5 (5.7%) in the Mycobacterium avium complex. Two isolates were identified as Mycobacterium acapulcensis and Mycobacterium cosmeticum by partial 16S rRNA gene sequencing. One isolate, unidentified by MALDI-TOF MS and yielding less than 92% and 96% sequence similarity with rpoB and hsp65 reference sequences, respectively, was regarded as a potentially new species. Samples from three patients exhibiting ≥2 Mycobacterium porcinum isolates and from one patient with emphysema and a lung abscess exhibiting 2 Mycobacterium senegalense isolates fulfilled the American Thoracic Society microbiological criteria for nontuberculous mycobacterial lung infection. Remote geographic areas, such as French Polynesia, are potential sources for the discovery of new mycobacterial species.     

Influenza A(H1N1)2009 in the French Pacific territories: assessment of the epidemic wave during the austral winter

The three French territories in the Pacific (New Caledonia [NC], French Polynesia [FP] and Wallis and Futuna [WF]) have been affected by an outbreak of influenza A(H1N1)2009 during the austral winter of 2009. This wave of influenza-like illness was characterized by a short duration (approximately 8 weeks) and high attack rates: 16–18% in NC and FP, 28% in Wallis and 38% in Futuna. The number of infected patients requiring hospitalization in critical care services and the number of deaths were, respectively, 21 and 10 in NC and 13 and 7 in FP (none in WF). Diabetes, cardiac and pulmonary diseases, obesity in adults, neuromuscular diseases in children, and Oceanic origin were frequently observed among severe cases and deaths. A significant proportion of the population remains susceptible to A(H1N1)2009, making the occurrence of a second wave likely. A state of preparedness and control efforts must be implemented, based on preventive measures (immunization), as well as combined clinical and virological surveillance and health organization.     

Outbreak of carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in a tertiary care hospital of Papeete, French Polynesia

Carbapenem-resistant Acinetobacter baumannii isolates were obtained from 24 patients between March and May 2004 at the Centre Hospitalier de Polynésie Fran?aise, Tahiti, French Polynesia. The isolates were multidrug resistant, produced the carbapenemase OXA-23, and belonged to a single clone presenting several subtypes, suggesting an endemic situation. This study further illustrates the global spread of this kind of beta-lactamase-mediated resistance.     

Zika virus: A new threat to human reproduction

Zika virus (ZIKV) was first isolated in 1947 in a rhesus monkey from the Zika forest of Uganda. Until 2007, only 14 human cases were reported. The first large human outbreak occurred in 2007 (Yap Island, Federated States of Micronesia, Pacific) followed by French Polynesia in 2013 and Brazil in 2015. The virus is mainly transmitted through Aedes mosquito bites, but sexual and post‐transfusion transmissions have been reported. Symptoms include low‐grade fever, maculopapular rash, conjunctivitis, myalgia, arthralgia, and asthenia. During the recent outbreaks in French Polynesia and Brazil, ZIKV infection has been associated with two major complications: microcephaly and Guillain–Barré syndrome. Since fetal infection includes other birth defects, congenital Zika syndrome has been used to define in utero infection. The majority of sexual transmission occurred from a symptomatic male to a female, but female‐to‐male and male‐to‐male transmission have been reported. Asymptomatic male‐to‐female transmission has also been described. Importantly, ZIKV RNA can persist at least 6 months in semen. The male urogenital tract may therefore act as a reservoir for the virus. ZIKV RNA was detected in a cervical swab of a patient 3 days after presenting the classic symptoms suggesting a potential tropism for the female genital tract. Long‐lasting presence of ZIKV RNA might not indicate that the individual is infectious but makes recommendation for couples potentially exposed to the virus and willing to conceive difficult. It will also be important to determine whether genital ZIKV infection might have a deleterious effect on male and female fertility.     

Prevalence of symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: the International Study of Asthma and Allergies in Childhood (ISAAC)

The International Study of Asthma and Allergies in Childhood (ISAAC) has provided valuable information regarding international prevalence patterns and potential risk factors for asthma, allergic rhinoconjunctivitis and eczema. However, the only Pacific countries that participated in ISAAC Phase I were Australia and New Zealand, and these included only a small number of Pacific children. Phase III has involved not only repeating the Phase I survey to examine time trends, but also to include centres and countries which are of interest but did not participate in Phase I. The ISAAC Phase III study was therefore conducted in the Pacific (in French Polynesia, New Caledonia, Tonga, Fiji Islands, Samoa, Cook Islands, Tokelau Islands and Niue). The overall prevalence rates of current symptoms (in the last 12 months) were 9.9% for asthma, 16.4% for allergic rhinoconjunctivitis and 10.7% for atopic eczema. The prevalence of current wheezing (9.9%) was generally much lower than that has been observed in Pacific children in New Zealand (31%), but there was considerable variation between the various Pacific centres: Tokelau Islands (19.7%), Tonga (16.2%), Niue (12.7%), French Polynesia (11.3%), Cook Islands (10.6%), Fiji Islands (10.4%), New Caledonia (8.2%) and Samoa (5.8%). The reasons for these differences in prevalence across the Pacific are unclear and require further research. The finding that prevalence levels are generally considerably lower than those in Pacific children in New Zealand adds to previous evidence that children who migrate experience an altered risk of asthma as a result of exposure to a new environment during childhood.     

Impact of a profound change in the structure of a society on the evolution of an endemic disease: leprosy in French Polynesia]

In French Polynesia the cases of leprosy are individually severe but the endemy itself always stood in low limits. The intensive use of modern treatments since 1950 have been making the eredication reasonably possible in the future. However the brutal demographic increase, the deep upsetting of the society and the important migrations made propitious conditions in the urbanized area for the advent of a new centre of infection. The result seems to be an increase of leprosy in the territory.     

The last offensive of leprosy in the South Pacific Ocean: the epidemic on Rapa (1922-1950)

The observations of leprosy outbreaks are exceptional and always situated in isolated countries. The authors give the example of Rapa, small island in French Polynesia, where an epidemic has occurred from 1922 to 1950. They made the study of the different parameters by retrospective methods and fieldwork. After an 11% incidence rate and an 68% prevalence rate, the outbreak seems today off. Now leprosy is endemosporadic.     

Epidemiology of primary liver cancer in French Polynesia

Thirty-one cases of primary liver cancer recorded since 1980 to 1988 in French Polynesia are studied. Four risk factors are brought to the fore: male, more than 50 years old, birth in Austral archipelago and in this case AgHBs carriage. The relative risk for birth in Austral archipelago reach to 9.23. The relative risk for AgHBs carriers from this archipelago reach to 42.7. Costs of primary liver cancer and to immunization against hepatitis B virus are compared. Authors suggest to start an immunization program.     

Significance of passive hemagglutination and its prospectives in lymphatic filariasis]

The authors analyze the data concerning 219 sera, that they have tested in passive hemagglutination, with as antigen a Dirofilaria immitis proteic extract, in French Polynesia. Besides its light sensitivity, this method does appear very interesting. It points out: --First, that there is a gaussian distribution of the results found at various dilutions, both by "filarian" and "non filarian" people. Therefore, this distribution is a feasible and practical parameter for evaluation of the Filariasis transmission in different populations. --On the other hand, that there is an inverse correlation between the presence of microfilaria in the blood and the level of immunological response for lymphatic Filariasis.     

Evaluation of 25 years of antileprosy chemotherapy in French Polynesia. Influence of age on the onset of the disease]

In French Polynesia the cases of leprosy are individually severe, like in Asia, but the endemy always stood under a relatively low level. A strong campaign of chemiotherapy has been conducted for 25 years. Unfortunatly the actions of systematic detection of new cases are not sufficient and the sanitary education is almost non existent. The territory is actualy reached by deep demographic and social upsettings and chemiotherapy used alone is not enough efficient to obtain a definitive decrease of the endemy or even to avoid, for a long time, a new increase. However a significant decrease of the age of advent of the decrease must be credited to the action of chemiotherapy.     

Prognostic factors associated with severe leptospirosis

Leptospirosis is an anthropozoonosis caused by Leptospira interrogans. It occurs worldwide and is endemic in French Polynesia. Leptospirosis is associated with a large variety of clinical symptoms. Most infections caused by leptospires are either sub-clinical or of very mild severity, but 5-10% of infections result in multiple organ damage, including kidney, liver and lung lesions. Among 71 patients hospitalised in Papeete for severe leptospirosis during a period of 2 years, the main risk-factors for a severe outcome were hypotension, oliguria and an abnormal chest auscultation at the first physical examination. Survival depends on rapid diagnosis and early appropriate management. Well-defined criteria may help physicians to improve the timely treatment of high-risk patients.     

Comparative immunological,pharmacological and biological characteristics of ciguateric toxin found in Ctenochaetus sp. from Tahiti and Hawaii

Ciguatera poisoning is a seafood intoxication resulting from the consumption of certain reef fishes. The source of the toxin(s) has been identified as a dinoflagellate, Gambier‐discus toxicus, which was first discovered in the waters of the Gambier Islands in French Polynesia where ciguatera is considered to be a significant public health problem. The G. toxicus was subsequently found to occur in many parts of the world, including Hawaii. This paper is concerned with the immunological, pharmacological and biological characteristics of a ciguateric toxin found in two closely related surgeon fish (Ctenochaetus sp.) from Tahiti and Hawaii. The toxin extracted from the two groups of fish was found to be pharmacologically identical, but that from the Tahitian group was more toxic than that of the Hawaiian fishes based on enzyme immunassay and mouse bioassay.