We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Murine typhus case was initially identified in Reunion, France, in 2012 in a tourist. Our investigation confirmed 8 autochthonous cases that occurred during January 2011–January 2013 in Reunion. Murine typhus should be considered in local patients and in travelers returning from Reunion who have fevers of unknown origin.

Malaria has been officially eradicated from the Reunion Island since 1979. However, a potentially active vector of the disease - Anopheles arabiensis - persists on the island. The risk of resurgence is quite significant. More than 90%of the patients presenting a malarial infection in Reunion Island after a stay in Madagascar or in the Comoros had followed a chemoprophylaxis that was not in accordance with the guidelines. A survey, that included 100 general practitioners, wasconducted in the Reunion Island regarding their practices concerning the malaria prevention. The upshot of all this is that these doctors themselves do not follow the optimal malaria prevention practices during journeys, and neglect their protection against mosquito bites. Travelers' consultations with the doctors before a journey represent only a modest part of their activity. However, the general practitioner is considered to be the interlocutor of choice for these patients. During these consultations, they do not refer enough to the national references which, according to a number of practitioners, are difficult to obtain. On the contrary, they refer too much to the information delivered by the pharmaceutical industry. With regard to the prescriptions of prophylactic treatments, only 40% of the doctors respect the official recommendations. This gap in the recommendations is sometimes deliberate and justified by the very high cost of a number of treatments. However, a lack of up-to-date knowledge cannot be excluded. Finally, the promotion of the protection against mosquito bites remains very poor. According to these data, it seems important to promote networking between the doctors and the reference centers, which would enhance optimal practices concerning chemoprophylaxis and protection against mosquito bites, especially targeting the "at risk" patients.

Background: Asymptomatic individuals (AIs) serve as reservoirs of pathogens associated with disease transmission. The objective of this study was to identify the presence and diversity of selected viral respiratory and gastrointestinal (GI) pathogens in AIs among residents of an informal settlement in Nairobi, Kenya.Methods & Materials: In 2006, KEMRI/CDC established a population-based infectious disease surveillance site within Kibera in Nairobi, Kenya. AIs (healthy controls) were enrolled as part of the system among persons who presented to the study's referral facility (Tabitha Medical Clinic). Persons presenting without current or previous 2 weeks history of fever, respiratory or diarrheal symptoms were eligible for enrollment as healthy controls. Following consent, participants provided stool and nasopharyngeal/oropharyngeal (NP/OP) specimens. Stool samples were tested by culture for bacterial pathogens and rotavirus by enzyme-linked immunoassay. Respiratory viruses were detected in NP/OP swabs by real time PCR.Results: Between 01 st November 2008 and 31 st December 2011, 384 stool samples and 779 NP/OP swabs were obtained from AIs. Pathogens were found in 23 (6.0%) of the 384 stool samples. Shigella, 10 (43.5%), was the predominant bacterial pathogen isolated; S. dysenteriae (10%), S. flexneri (70%), and 2 unsubtypable Shigella species. Other bacterial species identified included Campylobacter coli (4.3%) and C. jejuni (17.3%). Rotavirus was the only viral pathogen targeted for isolation; however, it was only detected in <2% of the participants (n=384; 1.8%). Of the 779 NP/OP swabs, adenovirus (11%), respiratory syncytial virus (RSV) (2.8%), human metapnuemovirus (hMPV) (2.7%), influenza virus type A and B (2.3 and 0.5%, respectively), parainfluenza (PIV) type 1, 2 and 3 (0.9, 1.0 and 1.9%, respectively) were detected. Adenovirus, hMPV, RSV, and influenza B were found more frequently in ages 5-17 years (28.1%, 33.3%, 45.5%, and 75% respectively). Adenovirus (78.9%) and all cases of RSV and PIV 1-3 in 18-34 years were identified more among females. Within the same age group Influenza A (85.7%) and hMPV (60%) were more common among males.Conclusion: AIs did show evidence of infection and could serve as reservoirs for these pathogens through close contact in this urban settlement especially among immunocompromised individuals.

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