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PubMed2002

Integrated control of peridomestic larval habitats of Aedes and Culex mosquitoes (Diptera: Culicidae) in atoll villages of French Polynesia.

An integrated larval mosquito control program was carried out in Tiputa village on Rangiroa atoll of French Polynesia. Mosquito abundance before and after treatment was compared with the abundance in an untreated village. Mosquito larval habitats consisted of large concrete or polyurethane cisterns, wells, and 200-liter drums. Depending on the target species, larval habitat category, its configuration, and purpose (drinking consumption or not), abatement methods consisted of sealing the larval habitats with mosquito gauze, treating them with 1% Temephos, covering the water with a 10-cm thick layer of polystyrene beads or introducing fish (Poecillia reticulata Rosen & Bailey). All premises of the chosen village were treated and a health education program explained basic mosquito ecology and the methods of control. A community health agent was trained to continue the control program at the end of the experiment. Entomological indices from human bait collections and larval surveys indicated that mosquito populations were reduced significantly, compared with concurrent samples from the untreated control village, and that mosquito control remained effective for 6 mo after treatment. Effects of the treatment were noticed by the inhabitants in terms of a reduction in the number of mosquito bites. In the Polynesian context, such control programs may succeed in the long-term only if strong political decisions are taken at the village level, if a community member is designated as being responsible for maintaining the program, and if the inhabitants are motivated sufficiently by the mosquito nuisance to intervene.

Aedes↗
PubMed1999

Variation in oral susceptibility to dengue type 2 virus of populations of Aedes aegypti from the islands of Tahiti and Moorea, French Polynesia.

Twenty three samples of Aedes aegypti populations from the islands of Tahiti and Moorea (French Polynesia) were tested for their oral susceptibility to dengue type 2 virus. The high infection rates obtained suggest that the artificial feeding protocol used was more efficient than those previously described. Statistical analysis of the results allowed us to define two distinct geographic areas on Tahiti with respect to the susceptibility of Ae. aegypti: the east coast, with homogeneous infection rates, and the west coast, with heterogeneous infection rates. No geographic differences could be demonstrated on Moorea. The possible mechanisms of this phenomenon are discussed in connection with recent findings on the variability of susceptibility of Ae. aegypti to insecticides.

Aedes↗
PubMed1992

Leprosy in French Polynesia. The possible impact of multidrug therapy on epidemiological trends.

In 1982, following the recommendations of a WHO study group, multidrug therapy (MDT) was introduced into French Polynesia to treat all patients suffering from active leprosy, and--only on request--those still on dapsone monotherapy. After 5 years, a clear-cut decrease of prevalence and mean annual detection rates for leprosy (except for detection rates among children aged less than 15 years, many of such cases being detected early by increased household contact training) has been observed. There was also a decrease in the proportion of newly detected cases with disabilities. During the 21-year period preceding the introduction of MDT into the control programme, mean annual detection rates for leprosy had remained stable, and this led to the consideration that such a decrease was due neither to the natural decline of the disease nor to the economic improvement of the country. Our results, together with the fact that, to date, the relapse rate was nil in the Polynesian patients put on MDT, strongly suggest that the implementation of MDT has resulted in a decrease of detection rates for leprosy which may be a consequence of a decrease in the transmission of the disease.

Clofazimine↗
PubMedDate not supplied

[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.

Adolescent↗
PubMedDate not supplied

[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.

Emigration and Immigration↗
PubMedDate not supplied

[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.

Adolescent↗
PubMed1992

[Epidemiologic surveillance of tuberculosis in French Polynesia between 1960 and 1990].

A monitoring and prevention policy for tuberculosis has been implemented in French Polynesia in 1960. Between 1960 and 1990, case-notification rate decreased dramatically from 568 to 30 per 100,000 with an average annual decrease rate of 9.1%. Cumulative case-notification rates calculated over the 30-year period for the 5 archipelagoes constituting the territory vary significantly: the highest rate has been observed in Gambier Islands. Sex ratio for the whole period was 1.1. The annual incidence rate, according to age-groups has been computerized using actuarial method. A cohort-effect is observed: given an age of individuals, the incidence rate becomes lower when shifting from an older cohort to a younger one. Also, an age-effect is to be emphasized: there is a decreasing trend of the rate in each cohort when the age of the individuals amid the cohort increases. The proportion of smear-positive tuberculosis cases increased from 38% in 1976 to 54% in 1990. A 0.57% annual risk of infection (ARI) has been estimated for 1977, and a 0.41% ARI for 1989. Tuberculosis mortally rate is documented since 1985, and varies between 10.8 and 2.1 per 100,000 since that year.

Adolescent↗
PubMedDate not supplied

[Leptospirosis in French Polynesia: 120 case reports].

Because of its clinical polymorphism and the difficulties to made a bacteriological and/or serological diagnosis, leptospirosis is an affection always non-detected. Nevertheless it is daily met affection in French Polynesia. Based on a homogenous series of 120 observations gathered from 1984 to 1990, all of them bacteriologically and/or serologically confirmed, we studied the different clinical and evolutive features of that disease. Fever is present in 91.6 p.c., cephalgia in 79.16 p.c. and myalgia in 70.83 p.c. Admission was necessary once out of four times. The four syndromes we observed in Tahiti are: infections syndrome, meningeal syndrome (30 p.c.) associated to an hyperproteinic grade in the C.S.F. (40 p.c.) and a lymphocytic reaction (60 p.c.). Liver syndrome, with hepatalgia (58.33 p.c.) and pain at the mass motion of liver (65 p.c.), that is an important sign in the local context; jaundice (28.33 p.c.) on the presence of which we must not based a diagnosis of leptospirosis: Biological renal syndrome displayed by transitory renal insufficiency with proteinuria, hematuria and leucocyturia. Neurological complications are mainly of encephalitic manifestations (5.8 p.c.). Hemorrhagic syndrome is expressed in digestive hemorrhage (8.33 p.c.) epistaxis (6.66 p.c.) and hemoptysis (6.66 p.c.). Cardiovascular manifestations are expressed in collapsus in 5.83 of the cases. Pulmonary abnormalities are frequent: cough (26.66 p.c.) and non specific X Ray image (19.16 p.c.). All patients are treated by Penicillin G (10 to 20 millions per day) by parenteral route with enteral alternative for an average of 10 days. Recovery was fast (7 to 10 days). In 65.8 p.c., slower in 15 p.c. (15 to 20 days); failure at first stage was observed in 10 p.c. of the cases, and relapse at medium or long term occurred under treatment in 8 cases (6.66 p.c.). Three dead were deplored (mortality 2.5 p.c.).

Adult↗
PubMedDate not supplied

[Hepatic amebiasis in French Polynesia. Study of 42 cases ].

The authors aimed at describing and analysing retrospectively the clinical, serological, anatomical and evolutive aspects of 42 cases of hepatic amoebiasis treated and followed up in Papeete (French Polynesia) from 1984 to 1990. Painful hepatomegalia with fever, was a revealing sign once out of two. Complications started at initial stage only twice. Amoebic serology (by immunofluorescence or hemagglutination) was always positive, while pathogenic amoeba was absent in 95.2 p.c. of the cases. Hepatic amoebiasis always produces an intra-hepatic collection of pus: to that point of view, superiority of echotomography on other methods of investigation is evident, particularly to diagnose multiple collections (45.25 p.c. in this series). Recovery was always got, in most of the cases by only a medical treatment (39 cases) or in association with a puncture (2 cases). Nitro-imidazol compounds are the preferred treatment. They were efficient in all cases but one, and were always followed by a systematic colic parasiticidal treatment with a contact amoebicide.

Adolescent↗
PubMedDate not supplied

[Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia].

Up till now, in the French Polynesia and in New Caledonia, people showing ciguatera intoxication receive a standard treatment: calcium + vitamins B6 and C by intravenous way and in addition, some drugs arriving to cure some symptomatic manifestations. In 1988, an investigation carried out in Majuro, Marshall Islands concluded that intravenous mannitol is efficient in the treatment of serious intoxications with suspecting cerebral oedema. Since, such a treatment has been utilized with success in several endemic areas. Our therapeutic evaluation was arrived to determine whether mannitol's efficiency is higher than the standard treatment in the ciguatera intoxications of mean seriousness. This investigation was carried out on two randomized groups: The first one receiving mannitol (250 cc intravenous at 20% injected in 1 h) the second one receiving the standard treatment (intravenous perfusion glucose serum 250 cc with 1 g of vitamins C, 250 mg of vitamin B6 and 1 g of calcium gluconate injected in 1 h). Seriousness of clinical status was evaluated according to a scale of score from 0 to 50, based on the importance of the clinical manifestations paresthesia, aches, asthenia, cardiovascular and digestive signs. Only patients getting a score at least 20 were included in this investigation. Clinical status of each patient was evaluated before any treatment (initial score) at the end of perfusion and at the 24th hour. Efficiency of each treatment respectively was evaluated according to the differences between these three different scores. CHI 2 and U Mann's and Whitney's tests were utilized for the statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Upper femoral epiphysiolysis in French Polynesia. Hip pain with serious consequences].

High femoral epiphysiolysis is a frequent disability in French Polynesia, occurring more in obese young people that being a morphotype quite frequent in this geographical area. It is often at the stage of acute epiphysiolysis or fixed coxa vara these patients are examined. At such stage, sequellae are major and evolving to precocious coxarthrosis. It is at a stage of progressive coxarthrosis at the beginning that treatment and recovery are possible without sequellae. Any practitioner has to think about it when confronted to any pain in a hip of teenager, so a surgical treatment, in good conditions could be performed.

Adolescent↗
PubMed1991

[Respective importance of vertical and horizontal transmission of hepatitis B in the Australian archipelago (French Polynesia). Preliminary results of the vaccination of newborns].

A seroepidemiological survey of hepatitis B was conducted in 1988 in the Austral archipelago (French Polynesia) in a randomly selected sample of 957 persons, has showed an infection rate (at least one positive marker) with HBV of 64.1% for the entire archipelago. Among women of child-bearing age, HBs Ag carriage rate was 11.45% of whom 19.1% were so HBe Ag carriers. Among infants HBs Ag carriage rate was 2.1% and among juveniles it was 10.6%. In this area horizontal transmission of HBV is essential. An immunization program was implemented in August 1988 using a recombinant vaccine (GenHevac BTM). At one year of the program, 97% of the children had received at least one dose of vaccine, 90% had HBs-antibodies titer higher than 10 mUI/ml, 96% had seroconverted for at least one of the two antibodies (anti-HBs and/or anti-preS2) and any of them was neither HBs Ag carrier nor anti-HBc IgM antibodies carrier. Finally, among 7 neonates whose mother were positive for both HBs Ag and HBe Ag, 6 were immunes and the last one, aged of 1 month (one dose received only), was not HBs Ag carrier. These preliminary results show that vaccination with GenHevac BTM to be immunogenic and effective in field conditions.

Adolescent↗
PubMedDate not supplied

[Hepatic amebiasis in French Polynesia. A study of 25 cases].

The authors report a retrospective study of 25 cases of hepatic amebiasis which were observed from 1988 to 1990 in Tahiti. The symptoms were typical in 20 patients and incomplete in 5 other patients. The ultrasonic examinations showed one (n = 14) or several abscesses (n = 11). The majority were located at the right lobe of the liver (84%). Except in one case where the abscess had a high echo response (it was a pseudo-tumour), the others showed a low echo response or were liquid. The serology (hemagglutination) was always positive but once, at the first examination or afterwards. Recovery was obtained by all patients on an average of 6 days for clinical signs and of three months for ultrasonic features, by administering Metronidazole, combined twice with a drainage (transcutaneous = 1 case, surgical = 1 case). Neither rupture, nor relapse occurred. This series is related to other studies made in South Pacific, Africa and France. It underlines the topicality of amebiasis in French Polynesia, and the interest for the Health Services to carry out a program against this endemy.

Adult↗
PubMed1991

[Our experience with bioprostheses in French Polynesia. A follow-up study from 1975 to 1988].

French Polynesia has unique social, cultural and geographic features. The prevalence of acute rheumatic fever (ARF) of 1.2 % population justified the health authorities' classification of this endemic as "major, severe, and prioritary" in 1984. Seventy per cent of patients with ARF develop cardiac sequellae which require surgery in 25 per cent of cases. Bioprostheses were considered from 1975 as the ideal valve replacement for these young, often undisciplined patients with no facilities for haemostatic control. Reoperation for valve degeneration has been increasingly frequent since 1982 and poses an acute problem leading to this statistic study and to a reflection as to the value of continuing to use this type of valve in this population. Analysis of 178 Polynesians with one or more cardiac bioprostheses in 1988, totalling 221 valves with a mean follow-up of 55 months, shows an actuarial survival rate excluding operative mortality of 86.7 +/- 3 % at 5 years (93.8 +/- 2.5 % in patients under 25 years of age, p = 0.001). Fifty-two patients (29 %) have been reoperated with a probability of being free of reoperation at 5 years of 70.1 +/- 4.2% (85.2 +/- 3.9 % in patients over 25 years of age and 43.8 +/- 7.8 % in patients under the age of 25, p = 0.002). The authors discuss the alternative of bioprostheses in this population : mechanical valves with anti-coagulant or anti-aggregant therapy, frozen aortic homografts, mitral valvuloplasty.

Actuarial Analysis↗
PubMed1990

[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.

Adenoma, Bile Duct↗
PubMed1990

[The detection of IgM antibodies to phenolglycolipid I for serodiagnosis of Hansen's disease and monitoring the contact population in Polynesia. Five year evaluation].

This study was conducted to assess the usefulness of IgM anti-PGLI antibody test, for the diagnosis of leprosy and of the subclinical infection among contact population. Even if the specificity (97.7%), sensitivity (98% for the multibacillary, but 36% for the paucibacillary) and efficiency (97.7%) of the test for the diagnosis of patients are good, its positive predictive value which is the proportion of true patients among the seropositive subjects detected in the population was very low (1.17% in Polynesia), because of the very low prevalence of leprosy. For the diagnosis of the subclinical infection, our experience based on the follow up of a population of 1,123 contacts, showed that such a control program would have low feasibility and low cost-effectiveness. After 5 years, the proportion of individuals developing the disease was not different among the seropositive than among the seronegative subjects. Finally, only 17.5% of the new cases of leprosy detected, were issued from the contact population followed. In conclusion and in a practical point of view, although this test may contribute to the diagnosis of patients, it is not likely useful neither for the diagnosis nor for the prognosis of leprosy in a population.

Antibodies, Bacterial↗
PubMedDate not supplied

[Health problems in an insular territory: the EVASANS in French Polynesia].

During the past three decades, French Polynesia has experienced a tremendous economic boom: GDP has multiplied by 30 in thirty years, whereas the population has only doubled in size. Health resources may nowadays be compared to those of a developed country. But as the "territory" is composed of a large number of islands, the availability of services is very uneven. The "Iles sous le Vent" are well staffed and well equipped, but other islands are under privileged. The small population of several small islands does not justify the permanent presence of a medical doctor. In this context, a system of health air-lifting was established. The system is classified into three groups: non-emergencies (scheduled for a later date), emergencies (immediate airlifting), and extreme emergencies (immediate airlifting with a doctor on board). Patients are airlifted to another island in the "territory" (mainly to Papeete, Tahiti), to New Zealand, or to France. The cost of this system (known as EVASANS) is extremely high. It raises the issue of improving local health care facilities and of promoting preventive medicine.

Delivery of Health Care↗
PubMedDate not supplied

[Infection with the human immunodeficiency virus (HIV) in French Polynesia].

HIV case finding tests are performed since three years in French Polynesia. Ratio of seropositivity is 2.4/10,000 inhabitants. The 45 seropositive patients found in three years belong to groups at risk (homosexual males; multi-transfusion recipients; addicts). As far as donors are concerned, no seropositivity was actually observed through the 16,881 tests carried out in 30 months. Outbreak of HIV seems to be recent in Tahiti.

Acquired Immunodeficiency Syndrome↗