Paris

You could not go to Paris without visiting some of its most famous sites. For February the weather was lovely, apparently it had been really cold the week before we arrived.

Eiffel Tower- where we climbed the 700 steps to the 2nd level.

Sacre Coeur and the Monmatre district with the artists painting on the streets

Louvre and Madame Mona Lisa

Site seeing aside the reason for my trip was to visit Sante publique France

Since May 2016 the National Institute for prevention and Health education, the Institute for Public health surveillance and the Health Emergency and Response establishment have amalgamated to form Health France. This combined organisation works to serve the population in all aspects of public health based on scientific knowledge , data and information. The agency supports the government and society in improving the health and well being in the population. It applies a population based approach with the objective of reducing social health inequalities in all areas of public health i.e infectious diseases, non infection diseases, environmental and occupational health. The Agency mission revolves around anticipate, understand and take action:

With regard to Lyme disease I met with Dr Julie Figoni who is a medical epidemiologist with an interest in Infectious, parasitic and tropical diseases and Sandrine Randriamampianina who works on marketing of prevention within the agency.

Lyme surveillance by Sante publique has been recorded since 2009 and is based on 3 different data collecting methods.

The 1st method is through a network of volunteer GP practices that input data for Lyme borreliosis along with 8 other diseases such as mumps. Since 2009 senital surveillance of Lyme borreliosis has been carried out through selected GP practices. Annual incidence from these reports remained stable between 2009-2015 ranging from 41-55 cases per 100,000 persons. 2016 saw that increase to 84 per 100,000. Important regional differences was observed, with the highest incidence observed in Limousin, Alsace and Rhône -Alpes region. Among the cases 95% presented with Erythema migrans. Also, Brittany sees cases all year round, in east France cases are identified only in summer

The 2nd data collection method is to look at the hospital data, patients admitted into hospital and have a Lyme disease code assigned, these tend to be the patients that have symptoms of disseminated disease. This includes neurological, cardiac and arthritic symptoms. To clarify a diagnosis of Lyme borreliosis there is a validation of cases process undertaken to ensure only true cases are included this is a multi agency process which includes GPS, staff at Sante publique and the Lyme reference laboratory.

The 3rd method is to collect data from at risk populations such as forestry workers, there is a study looking at sero-prevalence in this group, blood samples are taken and analysed for the presence of a number of disease this has been going on for a few years and the numbers remain quite stable.

There are also plans to undertake sero-prevalence studies of blood donations this will look for correlation between the number of identified cases of Lyme borreliosis and it will also hope to identify if the numbers are higher for those who have evidence on previous exposure but no disease symptoms.

Julie and Sandrine.

The data collected and analysed by the agency is published annually and also appears in eurosurveillance -the range of publications published can be accessed on this link:<https://www.eurosurveillance.org/search?value1=Lyme&option1=fulltext>.

Within the agency data publication there is also information on ticks, symptoms, tick removal and treatment recommendations.

Leaflets, posters and local media information is made available in the high risk areas and in the spring/ summer seasons when the general public are more at risk of being exposed to ticks. Emphasis is placed on the precautions that can be taken to prevent tick bites and how to remove ticks.

The agency is involved in the development and progress of the France national plan for Lyme disease. Prior to the publication the agency were commissioned to undertake a knowledge, attitudes and behaviour study with the general population, 65% had heard of Lyme disease, 1 in 4 people and been bitten and 1 in 5 thought they were at risk of exposure to Lyme disease. The study demonstrated that it did not present as high an issue as other public health matters such as vaccine preventable disease like meningitis etc. It is therefore important to find the correct balance of the actual disease burden when compared to other conditions but to also ensure people are aware of the risks particularly in the acknowledged high risk areas. Actions should be appropriate and should not be alarmist it is imperative that people continue to enjoy the environment and participate in outdoor activities.

Lyme disease is a very emotive topic and there is much publicised about the patients who suffer with long term effects but that needs to be balanced with those who get bitten by a tick and don’t get Lyme disease, those who present with Erythema migrans receive the correct treatment and recover completely and those who go out in the environment regularly and never get bitten.

The national plan was driven by the ministry of health and involved a wide range of groups, professionals and patients, and it identified actions on Epidemiology, diagnosis, treatment and prevention. Aspects of the plan remain disputed by some of the groups involved but work continues to improve the knowledge available in France.

I will return to Paris at the end of my trip to meet with other people.

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