The description and first results of the French Communicable diseases Network are reported. The network, initiated in November 1984, currently includes the National Department of Health, the local health offices and various clinical, biological, and epidemiological partners. Surveillance of influenza, viral hepatitis, acute urethritis, measles, and mumps is based upon reports from sentinel general practitioners throughout France who are equipped with terminals and can communicate their data on a 24-hour basis. The network distributes electronic bulletins summarizing the surveillance data, the regional statistics concerning other diseases, and epidemiological and administrative news. Electronic mail is used for data validation and enhances communication between the parties of the network. (Am J Public Health 1986; 76:1289-1292 Introduction Surveillance has been defined as a "continued watchfulness over the distribution and trends of incidence through the systematic collection, consolidation and evaluation of morbidity and mortality reports and other relevant data."' Surveillance allows health administrators to optimally allocate health resources2; in communicable diseases, effective surveillance is necessary to prevent the spread of diseases.3In most countries, including France, a notifiable disease reporting system is the basis for surveillance. It is recognized that the quality of reporting is generally high for severe and/or rare diseases but low for diseases of higher frequency and lesser severity. The sources of information for the surveillance of communicable diseases as well as the preventive measures involve a large number of individuals and institutions: physicians in hospitals or in private practice, clinical laboratories, and both medical and nonmedical sources. In the case of the more common illnesses such as influenza, viral hepatitis, or (in France) measles, general practitioners (GPs) are the most likely physicians to uncover the cases, yet their links with public health offices or with biological laboratories aie weak. This imposes a major limitation on the effective-

SummaryAnecdotal reports have suggested that reduced efficacy of pediculicides against Pediculus humanus capitis could be related to resistance to treatments.Ovicidal and pediculicidal activities of 0.5% malathion and 0.3% d-phenothrin lotions 'were tested in an experimental model of P humanus capitis grown on rabbits to ensure that the two treatments were pharmacologically equipotent. We then did a randomised controlled trial in which the lotions were administered to 193 P humanus capitisinfested schoolchildren (malathion, 95; d-phenothrin, 98). Success rate was defined as the absence of both live lice and viable nits. Before treatment, live lice were collected and subjected to a pediculicidal test. Pharmacological tests showed 100% killing of the rabbit-grown nits and lice after exposure to both pediculicides. On day 1 of the controlled trial, the success rate was 92% in the malathion group (95% CI, 0-86-0.97) and 40% in the d-phenothrin group (0.30-0.49) (pc0.0001); on day 7, it was 95% in the malathion group These results suggest an acquired resistance to d-phenothrin in the schoolchildren tested, since all other conditions of the administration of insecticides were standardised.

TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.

Hospital antibiotic management teams (AMTs) have been recommended, but, in France, their concrete implementation remains scarce and their effectiveness largely unevaluated. The objective of this investigation was to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSIs) at a 950-bed university teaching hospital, and assess the role of an AMT in improving it. A prospective analysis of all significant BSIs occurring outside of the intensive care unit (ICU) during an 18-month period was carried out. AT was deemed effective if at least one prescribed antibiotic was effective in vitro, and appropriate if it was consistent with local recommendations. Out of 574 BSIs, 512 were evaluated: 231 community-acquired, 206 nosocomial, and 75 healthcare-associated. For 219 (42.8%) BSIs, the AT initiated prior to AMT intervention proved to be effective and appropriate, inappropriate but effective in 136 (26.5%), and ineffective or absent in 157 (30.7%). In the multivariate analysis, hospital-acquired and other healthcare-associated BSIs, as well as catheter-borne (CB) infections, were associated with inappropriate or absent AT. A recommendation from the AMT was given and followed in 233 (94%) out of 249 BSIs requiring intervention. Initially, two-thirds of BSIs outside the ICU did not receive appropriate AT. Healthcare-associated BSIs should, therefore, be the priority target of AMTs.

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