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Antoine Flahault, MD, PhD

Coherence in response to Globalisation challenges. Chikungunya outbreak in Indian Ocean 2004-07 as a case-study. Antoine Flahault, MD, PhD. Chikungunya, a benign tropical disease?. Risk perception (April 2006) social – medical- epidemiologic. 266,000 cases

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Antoine Flahault, MD, PhD

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  1. Coherence in response to Globalisation challenges.Chikungunya outbreak in Indian Ocean 2004-07 as a case-study Antoine Flahault, MD, PhD

  2. Chikungunya, a benign tropical disease?

  3. Risk perception (April 2006)social – medical- epidemiologic • 266,000 cases • 255 death certificates with "chikungunya" • 40 neonatal transmissions • 2-4% of cases were hospitalised • 247 in ICU, • 63 deaths Médiane = 8

  4. From Mombasa (2004) to Ravena (2007) July 2007 Ravena, Italy 260 cases 12 1 133 17 2006-2007 India and Asia > 1.5 M cases 807 1 37 11 4 9 Kenya, June 2004 Lamu, Mombasa : seroprevalence 75% * Summer 2006 Indian Ocean 2nd wave 40 - 65% Jan-May 2005 Indian Ocean 1st wave adpaté de Charrel R et coll. NEJM, 2007

  5. Science, 21 déc. 2007

  6. WhyChikungunyadidemergeatthis place atthis time? Adamsberg, 2002

  7. APRIL 2004 MAY 2004 JUNE 2004 Lamu Mombasa Lamu Mombasa Lamu Mombasa Comores Mayotte Réunion

  8. Why such a strong second wave (en 2006)?

  9. La Réunion, 2005-2006

  10. Genome sequencing of chikungunya virus Indian Ocean : 92 sequences from 89 patients Mutation from A226 to V226 between the 2 waves Schuffenecker I et al., PLoS Medicine, 2006

  11. Twowaves but a unique epidemic force 3 < R < 4 Boelle et al., Vect Born Zoon Dis, 2007

  12. A rapidly available treatment?Tanslational research

  13. Ex-vivo model: chloroquine effect X. de Lamballerie, Unité des Virus Emergents, Marseille, mars 2006

  14. Le macaque : modèle animal • J1-J5: virémie détectable par RT-PCR • J2: fièvre, arthralgies fugaces • J1-J3: éruption diffuse modérée • J3-J5: oedème du cou, angine Le Grand, CEA, Sept. 2006 Le Grand, 2006

  15. Clinical trials • CuraChik : RCT chloroquine vs placebo, double blind, May 2006 • Sponsor: APHM ; PI: X de Lamballerie • Grant: Sanofi-Aventis • Sample size (calculated): 250 patients • Sample size (inclusions) : 75 pts => NS + 900 day-follow-up : natural history of Chik

  16. A rapidly available vaccine?

  17. Vaccine: R&D (Inserm) • Candidate-vaccine developed in the 80s by the US defense • An attenuated living strain of interest • US-French agreement for restart of developpement • Requalification stage • Trials on monkeys • Clinical developpement – industrialisation- stop?

  18. From B-A Gaüzère An effective mobilisation of citizens?

  19. Beliefs vis-à-vis routes of transmissions Desagreement Agreement Human transmission Airborne ransmission Mosquito Setbon et al . April 2006

  20. Kass-Moustik

  21. A sustainable anticipation?

  22. Risk of emerging vectorborne diseases Jones KE, Nature, 2008

  23. Center for research and surveillance in Indian Ocean • Recommended by the Chik task force in 2006 • Created in 2007 with 16 partners • President: Prof. JF Girard, IRD • Director: Prof K Dellagi • International Scientific Advisory Board • President: Prof. X de Lamballerie • Call for tender: 2008 • Pandemic influenza : 2009-2010

  24. An effective mobilisation of researchers?

  25. Chikungunya and scientific production Science, 21 Dec. 2007

  26. Conclusion (1/2) : The Convergence Model

  27. Conclusion (2/2) : Decision makers need more enlightment from research • Transmission routes (airborne, handborne) • Assessment of virulence • Assessment of prevention measures • Protective masks, hand washing, closing schools • Immunization strategies, Immunization of healthcare workers • Antivirals: how to prescribe them, what about combination (i.e. multitherapy), preventive and curative treatments • Treatment of severe forms • Disease surveillance, seroprevalence • Influenza in developing countries • Perceptions, attitudes, rumours, fears

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