Mainland France Research Articles

Biogeography of soil microbial habitats across France

AbstractAimIntensive studies since the beginning of the 21st century have provided vast amounts of knowledge about soil microbial diversity at local and global scales. However, microbial habitats have been poorly investigated at large scale. This study aims to characterize soil bacterial habitats across France for the first time by integrating the description of numerous environmental factors and human activities.LocationWe focus on the large spatial scale of mainland France using the largest spatially explicit soil sampling set available across France (2,173 soils, area = 5.5 × 105 km2).Major taxa studiedSoil bacteria and archaea were studied by a high throughput sequencing approach targeting the V3‐V4 region of the 16S ribosomal ribonucleic acid (rRNA) gene directly amplified from soil DNA.MethodsWe applied decision tree learning and geostatistical approaches combining the abundant data on soil microbes and large‐scale environmental description in order to conduct a comprehensive analysis of soil bacterial and archaeal communities.ResultsWe identified a complex mosaic of 16 distinct terrestrial habitats, based on soil type and management (pH, C : N ratio, land use). As for plants and animals, each habitat hosted generalist and specialist taxa and a specific interaction network directly or indirectly impacted by human activities.Main conclusionsIn a context of global change, our results emphasize that the policies for biodiversity and habitat conservation should now integrate soil microorganisms conceptually and technically.

Paving the way to coastal adaptation pathways: An interdisciplinary approach based on territorial archetypes

The attractiveness and urbanisation of coastal zones increase their vulnerability to climate change and sea-level rise, in particular to flooding and marine erosion. In the face of the projected increase in losses and damages, the anticipation and measures needed for adaptation involve physical, socioeconomic and political dimensions at different governance levels and timescales. A large literature addresses these various issues, generally in a targeted way. Drawing on adaptive policy pathways approaches and on research results of the past decade in mainland France, this article proposes an interdisciplinary characterisation of long-term adaptation pathways in coastal areas. Among the different variables and processes of change that characterise coastal zones and their future, particular emphasis is placed on social and institutional dynamics. This work contributes to the debate about adaptive governance in a highly uncertain context as well as to recent work to explore pathways and tipping points in support of climate adaptation policies.

RESIF RAP and RLBP Dataset of Earthquake Ground Motion in Mainland France

AbstractThis work presents the implementation of a high standards dataset of earthquake ground motions recorded in Metropolitan France between 1996 and 2016. This dataset is intended to serve the scopes of a large seismological community; however, its primary aims are engineering seismology and earthquake engineering applications. The dataset includes records from broadband and accelerometric sensors provided by permanent and temporary seismic networks operated by French research institutions and partners grouped within the Réseau Sismologique et géodésique Français (RESIF) consortium (see Data and Resources). All the waveforms are first homogenized to acceleration units and underwent a full quality control process including: (1) visual verification and manual phase picking, (2) processing scheme, and (3) consistency check by residual analysis. These make the dataset fully compliant with international standards. Finally, the RESIF dataset includes more than 6500 quality-checked records from 468 earthquakes recorded at 379 stations. Over the 379 stations included in the dataset, 177 are permanent stations (RA and FR networks) and 202 are temporary stations (YP and X7 networks). The dataset is complete down to magnitude ML 3.5 over the whole French territory and less (about ML 2.5) in the eastern part. Magnitudes range from ML 2.4 to 5.6 and from Mw 2.0 to 5.2, whereas distances range from less than 1 to 600 km. The disseminated dataset is constituted of (1) a versioned flatfile containing the metadata and main intensity measures computed on each processed record, (2) time histories, and (3) response spectra for several damping values and Fourier spectra.

The ‘Alsace European Authority’: a new step in the ‘territorial differentiation’ in France

ABSTRACT Alsace is a former regional authority which has been amalgamated into a new Grand Est (Greater East) region. After attempts to prevent the dissolution of their region, many elected representatives in Alsace implemented a rapprochement of the two Departments incorporating the former region, Bas-Rhin and Haut-Rhin, in order to continue to pursue a territorial policy throughout Alsace. This process caused high political tensions with the Grand Est Regional Council, where the Departments wished to retain some involvement despite the legal obligation to waive this jurisdiction. Territorial governance became more complex. An agreement was nevertheless reached at the end of 2018 to create the ‘Collectivité européenne d’Alsace’ (Alsace European Authority), a new Alsatian body within the Grand Est region following the merger of the two departments, entrusted with specific jurisdictions due to the importance of cross-border issues. This new type of body sets a precedent in mainland France (except Corsica). Its creation reflects, to a certain extent, an evolution towards greater ‘territorial differentiation’, a principle which calls into question the institutional organization uniformity of a unitary State such as France, to better adapt to specificities of each territory. This case study confirms only partly existing theoretical approaches.

Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes.

The epidemiology of severe acute poisonings in the French overseas departments of the Americas remains poorly reported. The main objective of this study was to determine the epidemiology and characteristics of severe acutely poisoned adult patients. Methods: A retrospective descriptive study was conducted from 1 January 2000 to 31 December 2010 in severely poisoned patients presenting to the emergency department (ED) of the University Hospital of Martinique, and the general public hospitals of Lamentin and Trinité. Results: During the study period, 291 patients were admitted for severe poisoning, giving an incidence rate of 7.7 severe cases/100,000 inhabitants. The mean age was 46 ± 19 years and 166 (57%) were male. Psychiatric disorders were recorded in 143 (49.8%) patients. Simplified Acute Psychological Score (SAPS II) at admission was 39 ± 23 points and Poisoning Severity Score (PSS) was 2.7 ± 0.8 points. Death was recorded in 30 (10.3%) patients and hospital length of stay was 6 ± 7 days. The mode of intoxication was intentional self-poisoning in 87% of cases and drug overdose was recorded in 13% of cases. The toxic agent involved was a therapeutic drug in 58% and a chemical product in 52% of cases. The predominant clinical manifestations were respiratory failure (59%), hemodynamic failure (27%), neurologic failure (45%), gastrointestinal manifestations (27%), and renal failure (11%). Polypnea, shock, ventricular fibrillation or tachycardia, and gastro-intestinal disorders were the main symptoms associated with death. The main biological abnormalities associated with death in our patients were metabolic acidosis, hypokalemia, hyperlactatemia, hypocalcemia, renal injury, rhabdomyolysis, increased aspartate aminotransferases, and thrombocytopenia. Extracorporal membrane oxygenation (ECMO) was used in three patients and specific antidotes were used in 21% of patients. Conclusions: Acute poisonings remain a major public health problem in Martinique with different epidemiological characteristics to those in mainland France, with a high incidence of poisoning by rural and household toxins.

Social deprivation among socio-economic contrasted french areas: Using item response theory analysis to assess differential item functioning of the EPICES questionnaire in stroke patients.

BackgroundMultiple approaches have been proposed to measure low socio-economic status. In France the concept of precariousness, akin to social deprivation, was developed and is widely used. EPICES is a short questionnaire that was developed to measure this concept. This study aimed to evaluate Differential Item Functioning (DIF) in the EPICES questionnaire between contrasted areas: mainland France, French West Indies (FWI) and French Guiana (FG).MethodsThe population was taken from the INDIA study, which aimed to evaluate the impact of social inequalities on stroke characteristics and prognosis. Eligible people were patients referred to neurology or emergency departments for a suspicion of stroke. We assessed the DIF using hybrid ordinal logistic regression method, derived from item response theory.ResultsWe analysed 1 553 stroke patients, including 768 from FWI (49.5%), 289 from FG (18.6%) and 496 from mainland (31.9%). We identified five items with a moderate to large DIF in area comparisons: “meeting with a social worker”, “complementary health insurance”, “home-owning”, “financial difficulties” and “sport activities”. Correlation between EPICES score and the latent variable was strong (r = 0.84).ConclusionThis is the first attempt to assess the DIF of the EPICES score between different French populations. We found several items with DIF, which can be explained by individual interpretation or local context. However, the DIFs did not lead to a large difference between the latent variable and the EPICES score, which indicates that it can be used to assess precariousness and social deprivation between contrasted areas.

The epidemiology and management of stroke in French Guiana

BackgroundFrench Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories. However, there is no further information on the epidemiology and management of stroke in French Guiana. Our goal was to describe the characteristics of patients in French Guiana in order to generate hypotheses regarding the determinants explaining the magnitude of this public health problem.MethodsWe used the data of the French multicentre INDIA prospective cohort study which included consecutive patients aged > 18 years with a first-ever stroke from June 2011 to October 2014. For the present study, only patients with ischemic or hemorrhagic stroke admitted in one of the 3 participating hospitals were analyzed.ResultsAmong the 298 patients (mean age 62.2 ± 14.5 years, 63.7% man) included in French Guiana, 52% were born abroad. Most strokes were ischemic strokes (79%), 14% of which were thrombolyzed. Hypertension (70.2%), history of smoking (22%) and diabetes (25%) were the most common risk factors and 28.4% of patients had known but untreated hypertension. Overall 89 (38%) patients with ischemic stroke were admitted less than 4.5 h after the first symptoms. In-hospital mortality was greater for intracerebral hemorrhage (18.7%) than for ischemic stroke (4.2%). Overall, 84.5% had health insurance coverage and among these, 41.9% had CMU, the universal health insurance for the poor.ConclusionsThe present study is the first epidemiologic description of stroke in French Guiana. The comparisons of these results show that stroke patients in French Guiana are epidemiologically atypical because they are younger, and more likely to be males than patients in mainland France. Stroke risk factors and delay between stroke and hospital admission were comparable with what is observed in France, suggesting that efforts should focus on primary care and social inequalities of health to alleviate the main determinants of stroke in French Guiana.

Simulation of fuel poverty in France

The assessment of fuel poverty in mainland France is based mainly on data provided by the French national housing survey. However, the last two surveys date from 2006 and 2014. To understand the change in the number of fuel poverty households, we have developed a microsimulation tool that takes into account the three predominant factors in the notion of fuel poverty, that is, household resources, energy prices and dwelling quality. Our tool includes three multiple linear models for estimating the following: 1. disposable income; 2. energy expenditure; and 3. the probability of performing a thermal renovation. We test our model with real values for variation in energy prices and variation in disposable income and a realistic number of housing renovations. The model is calibrated to the two last French national housing survey, matches the data very well and closely reproduces the number in fuel poverty in the 2012/2014 period. We not only evaluate fuel poverty in France in 2018 but also study the effects of variations in the unemployment rate, energy prices and number of thermal renovations.

Snake bites by European vipers in Mainland France in 2017–2018: comparison of two antivenoms Viperfav® and Viperatab®

Context: Today, immunotherapy with Fab or F(ab′)2 fragments is considered as a gold standard treatment for patients bitten by vipers. We compared the efficiency of two antivenoms, Viperfav® and Viperatab®, in mainland France in 2017–2018 with data provided by the French poison control centre (PCC).Methods: Patients with a moderate (2a and 2b) or severe (3) envenomation after a European viper bite and treated with immunotherapy were included and the markers chosen were the risk of post-antivenom treatment worsening, duration of hospital stay and persistent functional discomfort on day 15. Statistical studies were based on multivariate data analysis.Results: Two hundred and ninety-seven cases were recorded. One hundred and eighty-two (61.3%) patients received Viperfav® and 115 (38.7%) received Viperatab®. Compared to Viperfav®, use of Viperatab® significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p < .001). No significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15. Viperfav® and Viperatab® have a similar tolerance (p > .21). Otherwise, duration of hospitalisation was significantly increased by a delay of immunotherapy infusion of more than 12 h (OR 2.70; 95%CI [1.45–5.06]; p = .002) or a preventive administration of LMWH (OR 6.55; 95%CI [1.58–27.13]; p=.02).Discussion: While Viperfav® and Viperatab® have a similar tolerance, our data show that Viperatab® was associated with a higher risk of post-antivenom treatment worsening compared to Viperfav®. Furthermore, this study confirms that the antivenom should be used as soon as possible. Indeed, patients receiving the immunotherapy infusion from the grade 2b presented significantly more frequent exacerbated symptoms (OR 3.99; 95%CI [1.16–13.73]; p=.028) after the antivenom infusion compared to grade 2a group.Conclusions: Whereas no significant difference between these antivenoms was recorded with respect to the duration of hospital stay and persistent functional discomfort on day 15, use of Viperatab®, compared to Viperfav®, significantly increased the risk of post-antivenom treatment worsening (OR* 12.05; 95%CI [3.11; 46.70]; p < .001). Taken together, these data show that Viperfav® is the treatment of choice for the management of snake bites in France.

Out-of-maternity deliveries in France: A nationwide population-based study.

IntroductionIn France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality.Materials and methodsWe conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.ResultsThe distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]).DiscussionIn France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.

Clinical cases of Bluetongue serotype 8 in calves in France in the 2018-2019 winter.

Bluetongue virus serotype 8 (BTV-8) caused an epizootic in Europe in 2006/09. Transplacental transmission of BTV-8 was demonstrated leading to abortions, congenital malformations or nervous clinical signs in newborn calves. BTV-8 re-emerged in France in 2015. Although the re-emergent strain is nearly genetically identical to the one that had circulated in 2006/2009, it has caused very few clinical cases. However, from mid-December 2018 to April 2019, cases of calves with congenital malformations or displaying nervous clinical signs occurred in some departments (French administrative unit) in mainland France. Blood samples from these animals were sent to local laboratories, and the positive ones were confirmed at the French Bluetongue reference laboratory (BT-NRL). Out of 580 samples found positive at the local laboratories, 544 were confirmed as RT-PCR BTV-8 positive. The 36 samples found positive in the local laboratories and negative in the BT-NRL were all at the limit of RT-PCR detection. Hundred eighty-eight of the confirmed samples were also tested for the presence of Schmallenberg virus (SBV) and bovine virus diarrhoea virus (BVDV) infection: 4 were found positive for BVDV and none for SBV. The main clinical signs recorded for 244 calves, for which a reporting form was completed by veterinarians, included nervous clinical signs (81%), amaurosis (72%) and decrease/ no suckling reflex (40%). Hydranencephaly and microphthalmia were reported in 19 calves out of 27 in which a necropsy was practiced after death or euthanasia. These results indicate that the re-emergent strain of BTV-8 can cross the transplacental barrier and cause congenital malformations or nervous clinical signs in calves.

Statistical modelling of French drinking water pipe inventory at national level using demographic and geographical information

Abstract At the request of the French Ministry for Ecological and Inclusive Transition (MTES) and the French Biodiversity Agency (AFB), INRAE carried out a study focusing on the creation of a national asset knowledge base for drinking water networks, operating at Water Agency (WA) scale. Our study involved the creation of a number of statistical models. These models combine data relating to network characteristics (gathered from a sample of utilities) with geographical and demographical data collected from all municipalities in France. The SISPEA database, along with GIS data from a sample covering around half of the total French drinking water network, were used to configure multi-linear pipe models by diameter, installation period and type of material. On the basis of these models, the total length of drinking water pipes in mainland France was estimated to be 875,000 km. Networks are quite young (60% of the total length was laid after 1970), small diameter pipes are the majority (70% of the pipes have a diameter less than or equal to 100 mm) and the materials used are linked on geographic areas (pipes are mainly made of PVC in the west of France while cast iron pipes predominate in the other regions).

Assessment of bovine tuberculosis surveillance effectiveness in French wildlife: An operational approach

Bovine tuberculosis (bTB) is a chronic, zoonotic, bacterial disease mostly caused by Mycobacterium bovis, which can affect both domestic and wild species. France was officially declared bTB-free in 2001 but faced since 2004 an increase of the prevalence in cattle. Since 2001, bTB has been detected in several wild species: red deer (Cervus elaphus), roe deer (Capreolus capreolus), wild boar (Sus scrofa) and badger (Meles meles). Infected wild species constitute a major threat, because they may contribute to the maintenance of the infection in cattle and prevent eradication. In 2011, a surveillance system, Sylvatub, was implemented nationwide, to monitor the epidemiological status of bTB in mainland France. Our objective in this study was to assess the effectiveness of one of Sylvatub’s passive surveillance system components (SSCs), which is based on the visual inspection of hunted animals (wild boars, red and roe deer) throughout mainland France. The following effectiveness criteria were evaluated: individual-level and component group-level positive and negative predictive values, and individual-level and component group-level probabilities of type I error (“false-positive” error) and type II error (“false-negative” error). These criteria were estimated quantitatively, at the scale of the département (a French administrative area of similar size to a county), with a stochastic scenario tree model.Individual negative predictive values were high, whereas individual positive predictive values were poor, whatever the species considered, and the training of hunters did not improve these effectiveness criteria sufficiently. The individual-level probability of type I error was relatively low, but the individual-level probability of type II error was generally high and was therefore an issue. However, increasing the proportion of trained hunters decreased this probability effectively. At group level, the size of the population surveyed had a marked impact on the effectiveness criteria: both the component group-level negative predictive value and the component group-level probability of type II error decreased rapidly with increasing population size.The conclusions drawn from such rationale may directly benefit stakeholders and actors in the field in their day to day practice of the surveillance processes. Thus, the assessment method used in this article presents the advantage of being operational, as well as being applicable to any surveillance system.

Influence of shoreface morphological changes since the 19th century on nearshore hydrodynamics and shoreline evolution in Wissant Bay (northern France)

Located at the southern approaches to the North Sea, the Wissant Bay has had the most rapidly eroding shoreline in mainland France in recent decades. Using historical bathymetries spanning the second half of the 19th century to the present, an analysis of the long-term coastal morphological changes and evolution of a prominent sand bank (Line bank), extending across the bay, was carried out. A period of overall seabed erosion with a width-reduction of the Line bank; a deepening of the channel between the Line bank and the coast; and a lowering of the foreshore have been ongoing since the middle of the 20th century. This phase followed a period of channel infill in the western part of Wissant Bay in the early 20th century. Numerical modelling of wave propagation and tidal circulation was performed using the TELEMAC suite of models to get some insights into the influence of these bathymetry changes on coastal hydrodynamics. Two seabed configurations were identified revealing a contrasting hydrodynamic circulation. An erosional one induces an acceleration of tidal currents and an increase in wave height. Conversely, accumulation leads to an hydrodynamic regime weakening with a decrease in current velocity and to more wave energy dissipation in the nearshore. This study highlights the role of morphological feedbacks between nearshore morphology and coastal hydrodynamics. The identification of these feedbacks mechanisms at a historical time scale is important to assess potential drivers of coastal changes.

Maternal cumulative exposure to extremely low frequency electromagnetic fields, prematurity and small for gestational age: a pooled analysis of two birth cohorts

BackgroundData on the effects of extremely low frequency electromagnetic fields (ELF-EMF) on pregnancy outcomes are inconclusive.ObjectiveTo study the relation between maternal cumulative exposure to ELF-EMF during pregnancy and the risk...

Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods

ObjectivesStudies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. MethodsA study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. ResultsA total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital’s case mix significantly increased the probability that the hospital would be in deficit by 2.6%. ConclusionsReforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.

Leiomyomas in an African Caribbean hysterectomy population considered to be ethnically related to African Americans

BackgroundUterine leiomyoma has been reported to be a worse problematic disease for African American than Caucasian women in the US. Data are almost non-existent for other populations of African ancestry. Our aim was to investigate the hypothesis of an equivalent influence of ethnicity on uterine leiomyomas for women of a French African-Caribbean population. Basic proceduresRetrospective analysis of hysterectomies performed from 2010 to 2015 at the teaching hospital of Guadeloupe (French West Indies), where most inhabitants are of West African origin, was carried out. Data of the 899 hysterectomies, including those for malignancy, were collected, in particular, uterine weight. Main findingsThe indications were leiomyoma in 66.5 % of cases and leiomyomas were found in 91 % of all cases. The mean age and uterine weight were 51.7 years and 464 g for the entire population, 50.2 years and 488 g for the population without malignancies, and 47.0 years and 567 g for the population with leiomyomas. Principal conclusionsThe data were compared to those reported in the literature for several populations, notably African Americans and Caucasians in the US and mainland France. This comparison supports the hypothesis that Guadeloupean women, an African-Caribbean population, have characteristics in terms of uterine leiomyoma that are close to those of African Americans. Although confirmation is required, these results highlight the need for specific research, therapeutic approaches, and improved early management of these populations.

Colonialism and tourism in a French territory at the southern end of the world: the case of New Caledonia

ABSTRACTAt the southern end of the world, New Caledonia was annexed by France in 1853. It then became a colonial settlement. During that time, the indigenous population (Kanaks), faced racial segregation. For more than a century, its economic growth has been based on mining of nickel deposits. In this context, the development of tourism has been distinctive. I will analyse this in relation to the effects of the colonial situation. First, I will demonstrate the changing accessibility of New Caledonia by sea and air, with its regional marginalisation being due to customs assimilation with Mainland France which severely limited inbound tourism. I will then focus on the spatial and social diffusion of domestic tourism, stressing the role of the automobile and the late arrival of Kanaks in the tourism industry. Ending with outbound tourism, I will complete the analysis of New Caledonian tourism practices by identifying distinctive holiday experiences. My geo-historical approach will lead to the idea that the present distinctiveness specificity of New Caledonian tourism, which is still highly concentrated in the capital, Noumea, testifies to the maintenance of colonial legacies that prevents it from fully entering into a post-colonial dynamic in which the Kanak population would play a fundamental part.

Autochthonous chikungunya and dengue fever outbreak in Mainland France, 2010-2018

Abstract Background Aedes albopictus, vector of dengue and chikungunya viruses, is implanted in mainland France, exposing to the risk of autochthonous transmission. Since 2006, epidemiological and entomological surveillance activities aim to prevent or limit the occurrence of autochthonous cases. We aimed to describe episodes of transmission and control measures implemented in order to reflect on surveillance activities. Methods We reviewed all publications and documents produced on autochthonous transmission episodes in France and surveillance protocols. We reviewed surveillance activities, investigation methods and control measures implemented. Results Between 2010 and 2018, eight episodes of autochthonous dengue fever transmission and three of chikungunya were recorded in mainland France. All of them occurred in the South east of France, between July and October, when vector density was the highest. Transmission areas were limited to single domestic houses located in discontinuous urban areas. Only two episodes happened in two distinct areas. Chikungunya episodes led to 31 cases and dengue fever episodes to 23 cases. Most cases were identified by door-to-door investigations set-up in transmission areas. We isolated serotypes 1 and 2 for dengue and East Central South Africa lineage for chikungunya in autochthonous cases. Adulticide vector control measures were effective in controlling transmission. Seven episodes of transmission were due to failure in identifying primary imported cases. Four episodes occurred because of the absence or the lack of vector controls measures around primary imported cases. Conclusions Surveillance activities, and autochthonous cases investigations, were effective in limiting the extent of transmission, but were highly demanding for surveillance actors. Identified causes of transmission highlight the need of regular awareness campaigns targeting physicians and biologists. Key messages Effectiveness of the surveillance system of dengue, chikungunya and zika viruses, and autochthonous cases investigations. Needs of awareness and training courses targeting health professionals to the risk represented by these viruses.

Use and perceptions of electronic cigarette by the adult population in France in 2017

Abstract Background E-cigarette (EC) use is controversial because its benefit-risk ratio is still unclear. Since its introduction on the French market at the beginning of the 2010’s, French health authorities have published cautious recommendations. The study aims at describing uses and perceptions about EC among the adult population. Methods Santé Publique France’s Health Barometer, the French national public health agency, is a cross-sectional random survey conducted annually by phone, on a representative sample of the population aged 18-75 y/o in Mainland France. Descriptive analysis and logistic regressions were performed to analyze data collected from the 25,319 respondents of the 2017 edition. Results In 2017 in Mainland France, 3.8% of the population used an EC, 2.7% on a daily basis. Among EC daily users, 60.4% were men, 57.9% had a bachelor degree or higher qualifications. Less than 1% of EC users were never-smokers, 50.3% were daily or occasional smokers, 49.5% were former smokers. The number of daily ex-smokers who did quit smoking ( &amp;gt; = 6 months) and believed that vaping has helped them to, was estimated to be 700,000 since EC has been available in France. EC was perceived as equally or more harmful than regular cigarette by half of the population (51.5%), a proportion that has increased since 2014 (43.4%). Daily smokers perceived EC as more harmful, while being an EC user from high socioeconomic status was associated with the perception that EC is less harmful. The bans on EC in places where smoking is prohibited and on sales of EC to minors (&amp;lt;18 y/o) were appreciated by 66.9% and 77.5%, respectively. Conclusions These results show that in France, EC is strongly related to current or past smoking habits. A significant number of ex-smokers believe that EC has helped them quit smoking. Sociodemographic differences in the perception of EC harmfulness suggest social inequalities in access to information. Key messages Electronic cigarette users in France are few and most of them are smokers or former smokers. The perception of electronic cigarettes harmfulness depends on sociodemographic and smoking status.