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PubMed2001

[Epidemiologic surveillance of dengue fever in the French army from 1996 to 1999].

Dengue fever is a widespread disease that can occur outside tropical areas. Several thousand French military personnel are exposed to this infectious risk each year and exposure is expected to rise with the creation of a professional army and the increasing number of foreign missions. As a result, dengue fever has become a major priority for the Armed Services Health Corps (ASHC). A system of epidemiological surveillance based on the active participation of all military physicians has been designed by the ASHC to collect and analyze all data relevant to cases of dengue fever involving French military personnel stationed overseas or at home. The purpose of this study is to present data compiled for the period from 1996 to 1999. Analysis of these data demonstrated that the incidence of dengue fever peaked in 1997 due to epidemic outbreaks occurring in French Polynesia and Martinique. In response to these outbreaks control measures were adapted especially in regard to vector control. This study shows that the system of surveillance implemented by the ASHC is an effective but still perfectible tool.

Adult↗
PubMed2001

Molecular and morphological phylogenetic analysis of an insular radiation in Pacific black flies (Simulium).

Ecological adaptation within islands may have figured prominently in the insular radiation of black flies (subgenus Inseliellum) in the Society Islands, French Polynesia. To aid in understanding the sequence of ecological shifts in this group, we have constructed a phylogeny by using morphology, the cytochrome oxidase I (COI) gene, and the small ribosomal subunit (12S) gene. The strong influence of COI on the combined analysis tree was evident from its contribution to the partitioned Bremer support (62%). The net effect of including 12S was to reduce overall tree support. Different character sets resolved different portions of the combined analysis tree, with COI resolving recent lineages, 12S resolving basal relationships, and morphology supporting the monophyly of taxa having smaller larval feeding fans (oviceps group). The Partition Homogeneity and Kashino-Hasegawa tests indicated significant incongruence between morphological and mitochondrial data. The Templeton test revealed that morphology and the combined (COI + 12S) mitochondrial data were incongruent. This conflict stems primarily from disagreement over the monophyly of taxa having much smaller larval feeding fans. Either convergence in a subset of morphological characters, low phylogenetic signal among mitochondrial sequences, or lineage-sorting causing the mitochondrial data to track an incorrect evolutionary history may be responsible for these results.

Animals↗
PubMed1992

Study of factors that influence the clinical response to ciguatera fish poisoning.

A one-year observational study of all standardized medical records of ciguatera fish poisoning notified cases was conducted in French Polynesia. The objective was to determine the factors that influence the clinical response to ciguatera fish poisoning. During the year 1991, there were 551 cases notified on standardized code sheets by physicians (notification rate 276 per 100,000). The mean age was 36.6 years (SD 15.6). The largest age group was the 30- to 39-year-old one (138 cases, notification rate 970 per 100,000). Sex ratio (M/F) was 1.6. A clinical score was calculated to assess the outcome for each case. The adjusted odds ratio (OR) for a severe disease (33.2% with a score > 5) were significantly increased when the fish ingested was carnivorous (OR = 1.62, 95% Confidence Interval (CI): 1.07-2.45) and when a history of a previous attack was reported (OR = 1.71, 95% CI: 1.17-2.5). Men aged 30-39 years are at a higher risk to get ciguatera fish poisoning, whatever its severity. Severe diseases were observed when the ingested fish was carnivorous and in patients experiencing their second or more attack. This later finding could be related to an accumulation of toxin in the human organism.

Adult↗
PubMed1992

Socioeconomic impacts and management ciguatera in the Pacific.

The inshore fisheries resource is important to the health and culture of many of the inhabitants of Pacific Island countries (PIC). Ciguateric fishes (mainly demersal reef fishes) cause a range of distressing and often debilitating gastrointestinal neurological and cardiovascular disturbances. Consequently, ciguatera limits the utilisation of this otherwise over-exploited resource. For many victims, the symptoms suffered during the chronic phase of ciguatera (lasting weeks, months and occasionally years) are exacerbated upon consumption of certain foods, particularly non-toxic fishes. After each outbreak, victims and members of their social-network experience a transient increase in perception of the risk of eating reef fish. The impact of ciguatera is greatest in atoll island countries where fish is the primary source of protein (it also has a major impact and to facilitate the management of ciguatera in PIC, regular information is required that quantifies: (i) the true incidence of ciguatera; (ii) the extent and way in which different communities avoid ciguatera; and (iii) the adverse impact ciguatera has on health, the workforce, trade and tourism. Over the last 15 years (based on SPEHIS data to 1990), some countries recorded a decrease in the ciguatera problem (New Caledonia, Marshall Is.), other countries an increase (Kirbati, Tuvalu, French Polynesia), while still other countries recorded an increase followed by a decrease in ciguatera (Tokelau, American Samoa, Western Samoa, Fiji and Vanuatu). There may also be seasonal trends in the incidence of ciguatera in some countries e.g. Fiji. Management options presently implementable in PIC include: (i) treatment with i.v. mannitol; (ii) provision of timely advise on the location and status of ciguatera "hot spots" in each country that would allow affected communities to react objectively to the risk posed by ciguatera; and (iii) modification of human behaviour and aspirations to reduce the impact of increasing population, pollution and development (e.g. causeways) pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Ciguatera fish poisoning and fisheries development in the South Pacific Region.

Ciguatera fish poisoning represents an impediment to the development of fisheries based on shallow water reef fish stocks and to the food security of islands where agriculture is limited. Although fisheries development initiatives in the past 20 years in the Pacific have focused on the development of deep slope fisheries and fisheries for large pelagics such as tuna, shallow reef fisheries continue to be a major animal protein source for Pacific Islanders and a source of commercial revenue for fishermen. Statistics on ciguatera outbreaks in the Pacific are limited to local databases in Hawaii and French Polynesia, and to the compilation by the South Pacific Commission of "fish poisonings" reported by the medical departments of the countries of the region. A new database was established at the South Pacific Commission during 1990 to serve as a focus for detailed reporting of fish poisoning and ciguatera in the South Pacific. Some preliminary results from this database are presented and the importance of such information to the development of coastal reef fisheries is discussed.

Animals↗
PubMed1992

HTLV-I infection in selected populations in Australia and the western Pacific region.

The prevalence of infection with human T lymphotropic virus type I (HTLV-I) in 19,975 blood samples from Australia and the western Pacific was determined by measuring the presence of specific antibody (anti-HTLV-I) by enzyme-linked immunosorbent assay (ELISA) with confirmation by western blot and/or radioimmunoprecipitation techniques. In Australia no evidence of HTLV-I infection was found in injecting drug users, patients with the acquired immunodeficiency syndrome (AIDS), subjects attending a sexually transmitted diseases clinic, female prostitutes, or transfusion recipients. A low prevalence of infection was detected in people with haemophilia (0.5%) and in male homosexuals (0.5%-1%). No antibody was detected in sera from Vanuatu, Kiribati, American Samoa, the Cook Islands, New Caledonia, the Federated States of Micronesia, French Polynesia and Fiji, but a low frequency of anti-HTLV-I was detected in sera from the Solomon Islands (1.2%) and Nauru (0.6%).

Acquired Immunodeficiency Syndrome↗
PubMed1992

A comparative study of detection methods for evaluation of microfilaremia in lymphatic filariasis control programmes.

The evaluation of microfilaremia (mf) was performed in 96% of the population aged 15 years or more in a village of Moorea, one of the Society Islands in French Polynesia. Finger-prick and venous blood samples were collected simultaneously from 782 individuals in order to compare the results obtained by the standard blood film method and the membrane filtration technique. Of the 782 blood-sampled inhabitants 69 (8.8%) were found mf positive. 39 (5%) were mf positive by both methods and 30 were mf positive by the membrane filtration technique only. In these latter 30 carriers the geometric mean mf count was 19.7 mf/ml, significantly lower than that of 651.1 mf/ml in the 39 carriers positive by both techniques. Using the membrane filtration technique, the mf carrier prevalence rate increased from 1.9% in the youngest age group (15-19 years) to 16.9% in the oldest (< or = 60 years) while using the blood film method, it increased from 1.3% to 12.7%. Roughly, when using the membrane filtration technique, the mf carrier prevalence rate was 1.77 higher than that found using the blood film method, considering either the whole population or successive age-groups. Moreover, when using the blood film method in the 40 years and more age group, the mf carrier prevalence rate was 10%, a proportion similar to the 8.8% prevalence rate determined by the membrane filtration technique in the whole population. Further studies are planned to assess whether the last finding may be confirmed in other Polynesian populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

[Composition of renal stones currently observed in non-industrialized countries].

UNLABELLED: Up until relatively recently, renal stones in developing countries were considered to be very different from those observed in industrialized countries, essentially characterized by the predominance of phosphate and urate stones, while the predominant stones in industrialized countries are calcium oxalate stones. To verify whether this difference in the epidemiological profile is still observed today, we analysed renal stones collected in various regions of the globe and compared their composition to that of stones observed in France. MATERIAL AND METHOD: 1,042 stones were collected between 1991 and 2000 from 14 different countries or geographical zones: Sub-Saharan Africa (Cameroon, Mali, Senegal), North Africa (Algeria, Morocco, Tunisia), South America (Brazil, Paraguay), Asia Minor (Pakistan, Turkey), Far East (China, Laos, Vietnam) and French Polynesia (Tahiti). Stones were analysed by infrared spectrophotometry. The composition of these stones was compared to that of 24,706 stones collected in France over the same period and analysed according to the same protocol. RESULTS: Overall, the proportion of calcium oxalate stones was the same in adults in France and in developing countries (men: 75.7% contre 72%; women: 59.8% contre 56.3%), but was higher in children in non-industrialized countries (boys: 52.6% contre 31.8% in France; girls: 67.8% contre 48.8% in France, p<0.0001). The frequency of calcium phosphate stones was particularly low in boys in developing countries (8.3% contre 45.1% in France, p<0.0001) andfrequency of purine stones was higher in boys (21.3% contre 5.2% in France, p<0.0001) and in girls (13.6% contre 4.3% in France, p<0.05). Major differences were observed according to continent and region; struvite was present in 42.9% of stones in women in Sub-Saharan Africa contre 13% in South America and 2.7% in Asia Minor. Purines were 4 times more frequent in Tahitian men than in North African men. Calcium phosphate stones were 10 times less frequent in men in Asia Minor than in the Far East. CONCLUSION: The epidemiology of renal stones is continuing to change all over the world towards a predominance of calcium oxalate stones, which is now generalized. Major differences in the frequency of the other constituents, particularly purines and struvite, reflect particular eating habits and infectious risk factors specific to certain population.

Adult↗
PubMed2005

Characterization of deltamethrin resistance in field populations of Aedes aegypti in Thailand.

Five field collections of adult Aedes aegypti mosquitoes from different areas in Bangkok and Pathum Thani provinces were subjected to susceptibility tests against deltamethrin. Low levels of resistance were detected among all populations tested (RR50 = 8-17.2) compared to the susceptible strain, Bora (French Polynesia). Among the five populations tested, the BKH (Bang Khen, Bangkok) and PSC (Phasicharoen, Bangkok) populations showed a higher level of deltamethrin resistance than the other three populations (RR50 of BKH = 17.2, and of PSC= 13.6) and cross-resistance to DDT was observed in these strains. Biochemical analysis showed a significant elevation of mixed function oxidases enzyme activity in all populations. There was an elevation of non-specific esterases in all populations except BKL, and there was no consistent association of glutathione S-transferases with deltamethrin and DDT resistance, although not all populations were bioassayed for DDT. The partial cDNA sequence of the para-type voltage-dependent sodium channel (IIS4-IIS6) was determined for BKH and PSC populations. Common amino acid substitution, leucine to phenylalanine in the IIS6 region, found for insects including Anopheles gambiae was not found in either the BKH or the PSC populations. However, two other amino acid substitutions (proline substituted with serine at position 64 in the PSC population and leucine with phenylalanine at position 69 in the BKH population) were found in the IIS5-IIS6 inter-segment region sequenced. The role these substitutions play in target site resistance is uncertain at this time.

Aedes↗
PubMedDate not supplied

[The non-insulin-dependent diabetic (type II) in Tahiti].

The authors report on the monitoring in the Diabetology Service of the Territorial Hospital Center of Papeete (French Polynesia) of 51 Polynesians, diabetics non insulin-dependent over periods of 12 to 30 months (average 26.5 months) from July 1988 to December 1991. 31 males and 20 females (sex-ratio 1.5). Mean age: 55.9 (extremes: 22 and 76 old years). Non insulin-dependent diabetes risk factors: heredity (43%), obesity (67%), new-born babies with a weight more than 4 kg (10%). Revealing factors of diabetes: systematic check-up (37%), clinical complications (36%), cardinal signs (20%). Recorded complications are: 1. microangiopathy: nephropathy (25%) including 7 renal insufficiency and 2 patients under dialysis; retinopathy (29%); 2. macroangiopathy: cardiovascular accident 1 case; angor 4 cases; obliterative arteritis of inferior limbs 5 cases; 3. neuropathy 9 cases (17%); 4. high arterial tension 55%; 5. metabolic complications (20%): 4 acidocetosis; 2 hyperosmolar coma; 4 severe hypoglycemia; 6. 16 diabetic feet (32%) among them 8 amputations; 7. 45 infectious complications in 27 patients are reviewed. Review of the complications according to diseases ancientness; before 10 years of evolution, each patient suffered of at least one complication, after 10 years, each patient got an average of 2 complications. Review of diabetic balance: 80% of the patients present a mean glycemia greater than 1.50; 54% present a postprandial glycemia greater than 2 gr. and 34% a A1 C Hb greater than 9%. The possible treatments are reviewed. During this monitoring, mortality was one case; 35 patients were admitted totaling 881 days of hospitalization.

Adult↗
PubMedDate not supplied

[Goiter in Tahiti].

The authors report on a prospective study about goitre in French Polynesia carried out in 1989, dealing with epidemiology and disease characterization in 39 patients. 1. Epidemiology of goitre in Tahiti; In schools: 517 children (236 boys and 281 girls) aged from 10 to 15. Prevalence rate is 1.55 p.c. (8/517); Adults: 226 adults (112 males and 114 females) aged from 50 to 65. Prevalence rate is 4.42 p.c. (10/226). 2. Case study on 39 Polynesian patients (38 females and 1 male) living in Tahiti (mean age: 35.6 years old) showing euthyroidic goitre, detected from 1989 April 1st and October 31; Goitre did not present in Tahiti any particularity. It is a pathology mainly feminine, at low evolution and late local consequences; In 3/4 of the cases, goitre is visible and more it is voluminous more modules are present; There is no iodine deficiency, and the mean value of iodine excretion (536 mcg/24 h) is very high in comparison with what is described in the literature; Presence of a high thiocyanatemia (greater than 100 mmol/l) is found in 1/4 of the patients; There is no correlation between consumption of foods well-known as cyanogenical ones and the level of thiocyanatemia; There is a correlation between the rate of thiocyanatemia and tabagism.

Adolescent↗
PubMedDate not supplied

[Study of hyperuricemia in Tahiti. 31 cases hospitalized at the Territorial Hospital Center in Papeete (Tahiti)].

Frequency of gout in French Polynesia has induced us to define a type of "hyperuricemia Polynesian" from a population of patients admitted in a general Medicine Ward. Each admitted patient gets immediately a blood check-up. A figure higher than 70 mg/l in male and 60 mg/l in female is considered as pathological. In such a case, uricemia and uraturia are tested every 24 h for three days and we consider the mean value of these three tests. On the other side, some admitted patients non-hyperuricemic, are examined according to the same protocol. So, we have two groups: 31 hyperuricemics and 20 non-hyperuricemics, secondarily grouped according to age, sex, ethnic. We did not consider some secondary causes of hyperuricemia (chronic renal insufficiency diuretic treatment, psoriasis etc.). 1. Within the hyperuricemic population, mean uricemia is 85.35 mg/l versus 52.65 mg/l in the second sample. In the hyperuricemic group (21 males and 10 females) 48% are gouty and 13% of them are females. Articular manifestations are acute arthritis, affecting mainly inferior limbs, ankles, knees). We did not notice any significant divergence between uricemia and uraturia of gouty and non gouty people. Within the group of gouty people, percentage of individual hyper excretion is 53% (uraturia greater than 600 mg/24 h) with no significant divergence with the non-gouty group: Nephrolithiasis is rare (3%). There is no significant divergence between urinary pH of gouty and non-gouty people. Associated metabolic troubles are: diabetes (26%) high triglyceridemia (43%) three syndromes associated together (hyperuricemia + diabetes + hypertriglyceridemia) in 19.5%, total cholesterol is normal (2.07 g/l) but a low cholesterol (0.30 g/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Modernisation, migration and nutritional health of Pacific Island populations.

The emergence of obesity and fatness across the second part of the 20th century has been documented for a number of Pacific Island populations. While dietary change and reduced physical activity levels associated with economic modernisation have been identified as the key factors fuelling the emergence of obesity, it is argued here that increasing numbers of Pacific Island migrants in the United States, New Zealand, France and Australia have provided the basis for the acceleration of the modernisation process by way of remittances, and the transmission of ideas of economic opportunity and change. Potential for migration for the Pacific Island nations is estimated from available data on population growth, total fertility rates and total mortality rates. Pacific Islander migrants form approximately one quarter of the total global Pacific Islander population, the majority of whom are from Tonga, Fiji, French Polynesia, and the Federated States of Micronesia. Per capita energy and fats and meat intake for the period 1961 to 2000 is described for five Pacific Island nations, showing that, in general, energy intakes have increased, as have the energy densities of the diets consumed. Thus the increase in mean body mass index observed in Pacific Islanders in the second half of the twentieth century can in general be attributed to dietary change associated with greater food and energy intake, and with increased consumption of fatty foods and meat, most of which are imports.

Activities of Daily Living↗
PubMed2005

[Medical practice on the Leeward Side].

The daily practice of medicine in the remote Leeward Islands of French Polynesia is a particularly gratifying experience. The population of 1200 inhabitants is eager to receive continuous medical services after many years of waiting for better care. Relatively good access to various specialists working in the hospitals of Raiatea or Papeete and to emergency and scheduled medical evacuation services make medical practice far more attractive on the Leeward Islands than in remote communities in underdeveloped countries of Third World. The first cause of morbidity is overweight associated with a high incidence of type II diabetes and attendant complications.

Clinical Medicine↗
PubMed2006

Measles outbreak and response--Fiji, February-May 2006.

In September 2005, the 37 countries and areas of the World Health Organization (WHO) Western Pacific Region (WPR) established a goal to eliminate measles in the region by 2012. After multiple outbreaks in 1996 and 1997, measles supplementary immunization activities (SIAs) in 1997 and 1998 resulted in apparent interruption of measles transmission in WPR. Since then, importations have resulted in limited outbreaks in French Polynesia and Guam, a large outbreak in the Marshall Islands in 2003, and an outbreak in Fiji during February-May 2006. This report describes the epidemiologic findings, public health response, and potential causes of the 2006 outbreak that produced 132 measles cases in Fiji (2006 estimated population: 832,432), the most populous country in the South Pacific.

Adolescent↗
PubMed1991

Single versus repeated doses of ivermectin and diethylcarbamazine for the treatment of Wuchereria bancrofti var. pacifica microfilaremia. Results at 12 months of a double-blind study.

In October 1989, 58 apparently healthy Polynesian Wuchereria bancrofti carriers in whom microfilarial (mf) density was greater than or equal to 100 mf/ml were randomly allocated to treatment groups receiving single doses of either ivermectin at 100 mcg/kg or diethylcarbamazine (DEC) at 3 and 6 mg/kg. Six months later, half of the carriers initially treated with ivermectin 100 mcg/kg or DEC 3 mg/kg were given a second similar dose while the rest were given a placebo. By day 360 (6 months after retreatment), comparison of adjusted geometric mean mf counts per group indicated that (i) among the 3 treatments given once a year the DEC 6 mg/kg dose resulted in the highest efficacy, (ii) nevertheless, regarding either ivermectin 100 mcg/kg or DEC 3 mg/kg, 2 successive doses resulted in higher efficacy than one annual dose and (iii) though no significant difference could be evidenced between efficacy of ivermectin 100 mcg/kg and DEC 3 mg/kg given twice a year, DEC seemed to sustain the mf reduction for a longer period of time. During the 3 days following retreatment, adverse reactions (mild to moderate) were observed in 46% of carriers treated with microfilaricidal drugs and in 20% of those treated with placebo. These results suggest that single dose therapy with either DEC or ivermectin is safe and effective for prevention of lymphatic filariasis due to Wuchereria bancrofti in French Polynesia. The real impact on transmission by the vector, Aedes polynesiensis, of the complete negativation of microfilaremia observed during the previous part of the trial in carriers treated with ivermectin should be evaluated in a community-based trial including entomological study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Diagnostic values of ELISA-IgG4 as compared to ELISA-IgG and indirect immunofluorescence, for the routine diagnosis of bancroftian filariasis in the South Pacific. Application on capillary blood collected on filter paper.

For the serodiagnosis of lymphatic filariasis, serological assays restricted to the detection of specific IgG4 antibodies enhanced the specificity. In French Polynesia, Wuchereria bancrofti is the sole human filaria and other pathogenic parasites are infrequent. In order to define a simple and cheap serological test, we have compared the diagnostic value of indirect immunofluorescence test (IFI-WBp), ELISA-IgG and ELISA-IgG4 assays. The specificity, sensitivity, R.O.C. curves of each test have been analyzed. No significant difference was found between those 3 tests, except that the reproducibility and the predictive value were lower using IFI-WBp than using the two ELISAs. Significant correlation was found between IgG and IgG4 anti-Brugia malayi antibody titers (r = 0.512, p less than 10(-5)). For large scale seropidemiological studies, ELISA-IgG can be performed with finger prick blood absorbed on filter paper, but not ELISA-IgG4. In conclusion, ELISA-IgG a less expensive and less time consuming method than ELISA-IgG4, can be used for the routine serodiagnosis as well as for seroepidemiological studies on bancroftian filariasis in the South Pacific islands.

Animals↗
PubMed1991

Cumulative mortality rates in Aedes polynesiensis after feeding on polynesian Wuchereria bancrofti carriers treated with single doses of ivermectin, diethylcarbamazine and placebo.

During a therapeutic trial, batches of 672 to 1979 laboratory-bred Aedes polynesiensis, the mosquito vector of lymphatic filariasis in French Polynesia, were fed on Wuchereria bancrofti carriers one, three and six months after they had been treated with either single doses of ivermectin at 100 mcg/kg, diethylcarbamazine (DEC) at 3 and 6 mg/kg or placebo. High mortality rates were observed during the 15-day period following the blood-meal in mosquitoes fed on carriers treated with microfilaricidal drugs and were significantly higher in mosquitoes fed on carriers treated with ivermectin than in those fed on carriers treated with DEC. Though its intensity decreased with the passage of time, the phenomenon was observed in mosquitoes fed on carriers up to six months after treatment, especially in those fed on carriers treated with ivermectin. By decreasing the number of mosquitoes able to transmit the infection, this lethal effect on Ae. polynesiensis might represent an additional advantage of ivermectin in lymphatic filariasis control programs.

Aedes↗