Due to its geographic and demographic characteristics, Marseilles has always been a land of circulation for migrants coming from the Mediterranean Sea's neighbouring regions and from Africa. Founded by Greeks from Phocaea (now a Turkish city nearby Izmir), it is the oldest city in France and remains an important port for the South. Demographically, the population of Marseilles is naturally linked to the tropics. Each year around 150 cases of malaria are reported amongst Marseilles' residents, back from short stays in their countries of origin. Its geographical position and its demographic behaviours explain Marseilles’ particular exposure to infectious agents.
History counts three plague epidemics that started from the city: the first outbreak appeared between 1347 and 1353; the second in 1580, and the last one, the most lethal, in 1720. The last epidemic decimated the city and spread throughout Provence, killing between 90 000 and 120 000 people, out of a population of about 400 000 inhabitants. These epidemics have left deep marks in the history of the city, and they are at the origin of facilities dedicated to health care, diagnostic, teaching and research on infectious diseases, within the city and its immediate environment. However, Marseilles has experienced a unique historical evolution, and its opposition to the French monarchy has prevented the creation of academic structures that would have allowed medical schools to develop more efficiently. Nevertheless medicine has always been practiced at a high level, as evidenced by the creation by Bonaparte of the “Internat des Hôpitaux de Marseille”, immediately after that of the “Internat des Hôpitaux de Paris”. This created a gap between medical practice, renowned for its excellence, and the lack of formal institutions for medical teaching.
Eventually, a medical school was founded in Marseilles during the 19th century thanks to the "colonial" vocation of the city. In 1905, for geographical and historical reasons, the French Army established its training, expertise and research laboratories in tropical medicine at the Pharo.
Over the past 15 years, with more than 400 publications per year in international scientific journals, reporting studies mainly focused on clinical microbiology and infectious diseases, Marseilles has become a major centre of research in infectious diseases. Its research teams have made important contributions in the areas of zoonosis and vector-borne diseases, new infectious agents, bioterrorism agents, genomics of human pathogens, immunology against infectious diseases, and structural biology of infectious agents.
The University Hospital Centre of Marseilles has created the largest French laboratory of microbiology, the first civilian laboratory of detection of bioterrorism agents, and the first hospital unit with a Level 3 security. Within the hospital and the Faculty of Medicine, an infrastructure of translational research was developed, from the observation of patients to fundamental research, in order to study infectious agents and allow the identification of new microorganisms.
A unit of pathology of infectious diseases was also created. Consequently, more than 90 new human pathogens were originally described or grown in Marseilles. This includes the most common rickettsiosis transmitted by ticks (D. Raoult et al. N Engl J Med 2001 344.1504-10), the largest virus known on earth (Raoult D. et al. 2004 Science 306 0.1344 to 50) and the agent of Whipple's disease (Raoult D. et al. N Engl J Med 2000 342.620-25).
Following the report on bioterrorism in 2003, we have been focusing on three key points. First, the organisation of care to address the risk of highly contagious emerging diseases: we set up seven beds in a BSL3 facility and assessed their functionality. Thanks to this experience, we now know how to install this type of equipment. We have also introduced, for the first time in France, a diagnostic system for emerging pathogens available 24/24, each day of the year. These two elements have allowed us to develop a unique management strategy for the H1N1 pandemic; we have implemented a Point-of-Care (POC) in two major hospitals, including the reference hospital for infectious diseases, and we have tested more than 12 000 samples coming from the South of France; more than 2 000 of those were positive. In addition, we have shown that the risk of secondary transmission was much lower within a department of infectious diseases than in any other adult hospital department, and that casualty departments were not prepared for this type of situation. Finally, a new process for disinfecting hands was invented, by means of alcohol sprays, and implemented in Marseilles. It has now been extended to all hospital departments with great success. The implementation of the procedures listed above has led to observe a spectacular decrease of the multi-resistance of Staphylococcus aureus infections in France. Thus, our commitment over the past 10 years for the improvement of the organisation of care for patients with contagious diseases gave observable results.
Standardisation of protocols is the second major point we have been focusing on. This allowed us to publish the most efficient series on the treatment of endocarditis. In addition, we are among the few qualified centres in France for the management of bone and joint infections.
The protocols developed in the framework of the foundation of scientific cooperation “Infectiopôle Sud” and the care thematic network with Nice and Nimes will also allow standardising the management of AIDS patients. In addition, three axes were locally developed for the management of health problems specific to Marseilles. First, a system was set up to manage infections in homeless patients who are numerous in Marseilles. We also created a system of infections management within the travellers and residents of the Comorian community in Marseilles. Finally, we collected socio-economic and behavioural data to compare these with clinical cohorts.
The third important point is the epidemiological monitoring, especially through the application of the protocols and the implementation of clinical research. Travel medicine and tropical medicine have always been practiced and developed in Marseilles, and the city was recently recognised in this field with the appointment of P. Parola in Marseilles as the coordinator of European Centre for Disease prevention and Control (ECDC) for travel medicine. Two domains are particularly acknowledged: the surveillance of emerging diseases in travellers and the analysis of the risks of introduction of vector-borne tropical diseases in Europe, such as the dengue or the chikungunya.
diagnosis cases, realised in partnership with CMA-CGM, especially designed for emergency diagnosis on cruises; these include a validation system by text messages, directly linked to the IHU teams
the development of Point of Care (POC), mobile laboratories, allowing, within 18m² and one person, to answer in 4h to crucial clinical questions for the patient and his family (regarding hospitalisation, isolation, treatment and type of treatment)