Chikungunya virus infection may be responsible for very severe clinical presentation, including young patients with unremarkable medical histories. Chikungunya virus infection is strongly suspected to have neurologic, hepatic, and myocardial tropism leading to dramatic complications and high mortality rate.

BackgroundPregnant women have been identified as a group at risk, both for respiratory complications than for the admissions to the Intensive Care Unit (ICU) during the 2009 H1N1 influenza pandemic (pdm). The purpose of this prospective register-based cohort-study was to characterize the clinical virulence of the pdm (H1N1/09)v during pregnancy in La Réunion.Methods/Principal FindingsOver a twelve-week pdm wave (13 July to 3 October 2009), 294 pregnant women presented with an influenza-like illness (ILI) to one of the three maternity departments of the South Reunion area, Indian Ocean. Out of these, 278 were checked by RT-PCR for influenza viruses (157 positive and 121 negative, of whom, 141 with pdm flu and 132 with ILIs of non pdm origin, 5 untyped). The median body temperature was higher in women experiencing pdm flu than in those with non pdm ILI (38.9°C versus 38.3°C, P<0.0001), without evidence linked to circulating viremia. Oseltamivir was given for 86% of pdm flu cases in a median time inferior than 48 hrs (range 0–7 days). The hospitalization rate for pdm flu was of 60% and not associated with underlying conditions. Six viral pneumonia and fourteen asthma attacks were observed among 84 hospitalized pdm flu cases, of whom, only one led to the ICU for an acute lung injury. No maternal death occurred during the pdm wave. None adverse pregnancy outcome was associated with pdm flu. No congenital birth defect, nor early-onset neonatal influenza infection was attributable to pdm flu exposure.Conclusions/SignificanceThis report mitigates substantially the presumed severity of pandemic H1N1/09 influenza infection during pregnancy. The reasons for which the clinical burden of H1N1/09 influenza virus may differ worldwide raise questions about a differential local viral-strain effect and public health preparedness, notably in timely access to special care and antiviral treatments.

On Reunion Island, in response to the threat of emergence of the pandemic influenza A(H1N1)2009 virus, we implemented enhanced influenza surveillance from May 2009 onwards in order to detect the introduction of pandemic H1N1 influenza and to monitor its spread and impact on public health. The first 2009 pandemic influenza A(H1N1) virus was identified in Réunion on July 5, 2009, in a traveller returning from Australia; seasonal influenza B virus activity had already been detected. By the end of July, a sustained community pandemic virus transmission had been established. Pandemic H1N1 influenza activity peaked during week 35 (24-30 August 2009), 4 weeks after the beginning of the epidemic. The epidemic ended on week 38 and had lasted 9 weeks. During these 9 weeks, an estimated 66 915 persons who consulted a physician could have been infected by the influenza A(H1N1)2009 virus, giving a cumulative attack rate for consultants of 8.26%. Taking into account the people who did not consult, the total number of infected persons reached 104 067, giving a cumulative attack rate for symptomatics of 12.85%. The crude fatality rate (CFR) for influenza A(H1N1)2009 and the CFR for acute respiratory infection was 0.7/10 000 cases. Our data show that influenza pandemic did not have a health impact on overall mortality on Réunion Island. These findings demonstrate the value of an integrated epidemiological, virological and hospital surveillance programme to monitor the scope of an epidemic, identify circulating strains and provide some guidance to public health control measures.

Emergence of Klebsiella pneumoniae and Salmonella Metallo-Beta-Lactamase (NDM-1) Producers on Reunion Island T he first incident we report here, which occurred on 16 November 2011, involved a 59-year-old French man who was admitted to a Mauritius hospital for decompression sickness. The patient was transferred on 18 November to the French Hospital in the south of Reunion Island. The patient did not receive any antibiotic therapy. In France, patients transferred from a hospital abroad must be screened for multidrug-resistant bacteria (MDR) in the feces. On the day of admission, a rectal screening for MDR was performed on chromID ESBL (extended spectrum ␤-lactamase) medium (bioMérieux, La Balme-Les-Grottes, France). A strain of Klebsiella pneumoniae was isolated, which Vitek Compact testing (bioMérieux) showed to be resistant to imipenem and ertapenem according to the criteria of the European Committee on Antimicrobial Susceptibility Testing. The modified Hodge test (1) with an ertapenem disk was negative for this strain. The isolate was subsequently tested for carbapenemase and ESBL genes by Check-MDR CT102 (2) (Check-Points Health BV, The Netherlands) and was positive for the NDM-1 carbapenemase and CTX-M group 1 ESBL genes. The second incident we report, which occurred on 12 March 2012, involved a 73-year-old French man who was transferred from India to the same unit on Reunion Island. The patient was originally hospitalized in late December 2011 with an intracranial bleed in an Indian hospital (Chennai). On 29 December, the patient was febrile with purulent endotrachealsecretions.AnESBL-producingKlebsiellapneumoniaestrainwas isolated from the patient's sputum. Treatment with unknown antibiotics wasinitiated,buton16January,becausethepatientwasstillfebrile,urine, blood, and endotracheal secretions were cultured. The following bacteria were isolated from these samples: ESBL-producing Escherichia coli (urine) and ESBL-producing Klebsiella pneumoniae (bronchoalveolar lavage [BAL] fluid obtained by blind BAL [mini-BAL]). After recovering, the patient was transferred to Reunion Island. Upon the patient's arrival, a rectal swab was cultured on chromID ESBL medium. Escherichia coli and Klebsiella pneumoniae grew on this medium. An ESBL phenotype was confirmed by a double-disc diffusion synergy test (discs of amoxicillin-clavulanic acid, ceftazidime, cefotaxime, aztreonam, and cefepime). A Salmonella sp. strain resistant to imipenem was isolated from a sample of urine. The serotype of this Salmonella strain was not identified by our common set of working antisera, and the strain was therefore sent to the National Reference Center (CNR E.coli/Shigella/Salmonella; Institut Pasteur, Paris, France). CNR identified Salmonella enterica subsp. enterica serotype Westhampton. This Salmonella strain was also isolated from a second sample of feces after selenite broth enrichment. MICs were determined (Vitek) for the Salmonella strain,andthemodifiedHodgetestwaspositive.Thisstrainwastestedfor carbapenemase genes by Check-MDR CT102 an...

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