Epidémiologie clinique: définitions, utilités et raisons pour un développement en Suisse. [Clinical epidemiology: definitions, uses and reasons for development in Switzerland].

Clinical epidemiology is the most currently used name for a comparatively new branch of medicine covering a certain number of activities related to the practice of clinical medicine, but using epidemiological techniques and methods. Clinical epidemiology has only just begun to be known in Europe, whereas units are being increasingly developed and expanded in North America, particularly within the clinical departments of hospitals. The methods it offers are valid for both practicing physicians and hospital doctors (or those being trained in hospitals) and serve the purpose of promoting a better quality medical service, especially where a more adequate evaluation of the effectiveness of diagnostic methods, therapy and prognosis in medicine is concerned. Clinical epidemiology proposes a methodology of medical reasoning and of decision-making, as well as techniques intended to facilitate the indispensable task of keeping up with advances in medical knowledge.

Transmission factors in malaria epidemiology and control in Africa

Genetic and environmental components of factors contributing in malaria transmission are reviewed. Particular attention is given to density dependent regulation of vector populations in relation to the survival rate anophelines. The expectation of vector activities are different according to the epidemiological characteristics of malaria, mainly its stability. In areas with perennial and high transmission (stable malaria) vector control could reduce malaria related morbidity and mortality, whithout any effect on the endemicity. However this need further investigations. In areas where the transmission period is very short (unstable malaria), vector control will have an important impact on the disease and the endemicity. Control projects using indoor spraying with insecticide and impregnated bed nets are discussed.

Recent advances and prospective researches on molecular epidemiology of dengue viruses

The determination of amino acid changes in the envelop protein by direct sequencing of either genomic RNA or PCR-amplified cDNA fragments provides useful informations for assessing the genetic variability and the geographic distribution of the actually most widespread dengue-2 serotype. The possible link of variations in the envelope protein-gene and virus virulence is discussed.

The dermal leishmaniases of Brazil, with special reference to the eco-epidemiology of the disease in Amazonia

Six species of Leishmania are at present known to cause cutaneous and/or mucocutaneous leishamniasis in Brazil, and they are all to be found in the Amazon region of this country. The eco-epidemiology of each is discussed, with the observation that the Amazonian leishmaniases are all zoonoses, with their source in silvatic mammals and phlebotomine sandfly vectors. With man's destruction of the natural forest in southern Brazil, some sandfly species have survived by adapting to a peridomestic or domiciliary habitat in rural areas. Some domestic animals, such as dogs and equines are seemingly now involved in the epidemiology of the disease. No such process has yet been reported in the Amazon region, but may well take place with the continuing devastation of its forest.

Methicillin-resistant Staphylococcus aureus infection after lung transplantation: 5-year review of clinical and molecular epidemiology.

BACKGROUND: Data on the epidemiology of MRSA infection in lung transplantation is limited. METHODS: We performed a 5-year retrospective study to assess the incidence and microbiologic and clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) infection in a cohort of 163 lung transplant recipients. RESULTS: Seventeen patients with MRSA colonization and/or infection were identified, for a calculated incidence rate of 76.1 cases per 1,000 transplanted-years. Pulsed-field gel electrophoresis identified 3 different distinct MRSA profiles, all of them consistent with hospital-associated MRSA infection. CONCLUSION: Despite negative polymerase chain reaction (PCR) for the virulence factor Panton-Valentine leukocidin, MRSA infections resulted in significant disease and morbidity.

Immuno-epidemiology of Schistosoma mansoni infections in a recently exposed community in Senegal

The levels of IgE and IgG4 increased strongly between cohorts, indicating a dynamic immunological situation, but no immediate impact on infection levels. Morbidity was little specific abdominal discomfort was reported by 61%, diarrhoea by 33% of the subjects; mild hepatomegaly was found in 16%, splenomegaly in 0.5%. No relation to egg counts was observed for any symptom. This mild morbidity may be due to the recent nature of the focus. In the first cohort, the percentage of people with negative egg counts ten weeks after treatment was only 18%, though egg counts declined strongly. Antigen detection confirmed these results. Praziquantel treatment provoked transient but impressive side effects (colics, vomiting, urticaria, aedema), the occurrence of which correlated with intensity of infection. Cure rates in subsequent cohorts were followed up shorter after treatment but remained low. Reinfection nevertheless oppears limited. This lower drug efficacy may be due to very rapid reinfection and/or to the lack of immunity in the population, but also reduced susceptibility of the local parasite strain must be considered and studied.

A possible correlation between the host genetic background in the epidemiology of Hepatitis B virus in the Amazon region of Brazil

The Amazon region of Brazil is an area of great interest because of the large distribution of hepatitis B virus in specific Western areas. Seven urban communities and 24 Indian groups were visited in a total of 4,244 persons. Each individual was interviewed in order to obtain demographic and familial information. Whole blood was collected for serology and genetic determinations. Eleven genetic markers and three HBV markers were tested. Among the most relevant results it was possible to show that (i) there was a large variation of previous exposure to HBV in both urban and non-urban groups ranging from 0 to 59.2%; (ii) there was a different pattern of epidemiological distribution of HBV that was present even among a same linguistic Indian group, with mixed patterns of correlation between HBsAg and anti-HBs and (iii) the prevalence of HBV markers (HBsAg and anti-HBs) were significantly higher (P=0.0001) among the Indian population (18.8%) than the urban groups (12.5%). Its possible that the host genetic background could influence and modulate the replication of the virus in order to generate HB carrier state.

The use and mis-use of some ecological terms and concepts in epidemiology

The article discusses the current use and mis-use of ecological terms and concepts in epidemiological literature, and in special, in works dealing with zoonotic diseases. A selection of examples was taken from papers recently published on the transmission of Chagas' disease by Triatoma sordida. Proper definitions are listed, with the intent of helping non-ecologists to use those terms and concepts correctly.

The epidemiology of malaria in Prábis, Guinea-Bissau

This article reports upon a community survey of malaria in Prábis, Guinea-Bissau. A house to house census of the population was initially carried out from August to December 1991(rainy season). After completing the census of each village, the population was invited to come, a week later, to a central point, where they were medically examined and finger-prick blood samples were collected for epidemiological characterization of the malaria situation in the area. The blood films of the one single village were used to compare the sensitivity and specificity of Polymerase Chain Reaction (PCR) with optical microscopy detection of parasites. In another village, the occurrence of parasitaemia was compared in children with and without fever. During the dry season, from March to June 1992, the population in each village was again invited to come to a central point. Some of the field procedures were repeated. The study revealed Prábis as an administrative Sector of Guinea-Bissau with endemic malaria, mostly due to Plasmodium falciparum, but with a significant rate of mixed infections. Active transmission occurred throughout the year, but it was more intensive during the rainy season and in the northwestern quadrant of the Sector. The level of endemicity of the villages varied from hypo to holoendemic. The factors associated with the differences among villages included village size and predominant economic activity (closeness to rice fields). The transmission paradigm was, most likely, a mixture of malaria of the African wet Savannah and malaria associated with irrigated paddy fields. PCR proved to be a sensitive method with low specificity during the dry season. Pyraexia of 37.4ºC or higher in children aged 2-9 years is not a sensitive indicator of parasitaemia but, it is highly specific and it has a clinically useful predictive value.

Poor value of pulsed-field gel electrophoresis to investigate long-term scale epidemiology of methicillin-resistant Staphylococcus aureus.

Pulsed-field gel electrophoresis (PFGE) is widely used for epidemic investigations of methicillin-resistant Staphylococcus aureus (MRSA). In the present study, we evaluated its use in a long-term epidemiological setting (years to few decades, country to continent level). The clustering obtained from PFGE patterns after SmaI digestion of the DNA of 20 strains was compared to that obtained using a phylogenetic typing method (multiprimer RAPD). The results showed that the analysis of small PFGE bands (10-85kb) correlates better with multiprimer RAPD than the analysis of large PFGE bands (>85-700kb), suggesting that the analysis of small bands would be more suitable for the investigation of long-term epidemiological setting. However, given the technical difficulties to obtain a good resolution of these bands and the putative presence of plasmids among them, PFGE does not appear to be a method of choice for the long-term epidemiology analysis of MRSA.

The Changing Face of the Epidemiology of Tuberculosis due to Molecular Strain Typing: A Review

About one third of the world population is infected with tubercle bacilli, causing eight million new cases of tuberculosis (TB) and three million deaths each year. After years of lack of interest in the disease, World Health Organization recently declared TB a global emergency and it is clear that there is need for more efficient national TB programs and newly defined research priorities. A more complete epidemiology of tuberculosis will lead to a better identification of index cases and to a more efficient treatment of the disease. Recently, new molecular tools became available for the identification of strains of Mycobacterium tuberculosis (M. tuberculosis), allowing a better recognition of transmission routes of defined strains. Both a standardized restriction-fragment-length-polymorphism-based methodology for epidemiological studies on a large scale and deoxyribonucleic acids (DNA) amplification-based methods that allow rapid detection of outbreaks with multidrug-resistant (MDR) strains, often characterized by high mortality rates, have been developed. This review comments on the existing methods of DNA-based recognition of M. tuberculosis strains and their peculiarities. It also summarizes literature data on the application of molecular fingerprinting for detection of outbreaks of M. tuberculosis, for identification of index cases, for study of interaction between TB and infection with the human immunodeficiency virus, for analysis of the behavior of MDR strains, for a better understanding of risk factors for transmission of TB within communities and for population-based studies of TB transmission within and between countries