STRATEGIE DE FREINAGE DE LA PROPAGATION DES VARIANTES DU SARS-COV-2 : PRECISIONS POUR LA DETECTION DES VARIANTES ET LE RENFORCEMENT DU CONTACT-TRACING
Mesdames, Messieurs,
Dans la continuité du DGS Urgent n°5, le présent message vient préciser les modalités de déploiement des kits RT-PCR spécifiques des variantes disponibles dès aujourd’hui et de renforcement du dispositif de contact-tracing.
Des kits RT-PCR spécifiques des variantes sont utilisables à partir du samedi 23 janvier 2021 sur l’ensemble du territoire (la liste est intégrée sur la plateforme du MSS et sera mise à jour régulièrement https://covid-19.sante.gouv.
Dès samedi 23 janvier 2021, une seconde RT-PCR de criblage est réalisée à l’ensemble des résultats positifs de RT-PCR Cette RT-PCR de criblage est réalisée avec l’un des kits détectant une ou plusieurs variantes connues à ce jour et a minima la variante VOC 202012/01.
Cette stratégie de double analyse ne concerne pas les tests antigéniques. Toutefois, les personnes ayant été diagnostiquées positives à la suite d’un test antigénique et qui se situent dans une situation à risque (retour de voyage, clusters et zones d’augmentation forte et inexpliquée de l’incidence (uniquement sur quelques cas pour échantillonnage dans ces deux dernières situations)) doivent être invitées à réaliser un test RT-PCR.
Les laboratoires de biologie médicale doivent conserver les prélèvements ayant donné lieu à une RT-PCR afin de permettre la réalisation d’un second test de criblage aux variantes, et sont tenus d’envoyer sans délai aux plateformes réalisant ce deuxième test les prélèvements ayant donné lieu à un résultat de RT-PCR positif. Il est essentiel de saisir sans délai dans Si-DEP les résultats de cette deuxième RT-PCR selon le mode opératoire qui sera transmis. Des développements de l’outil SI-DEP ont été réalisés pour accueillir les résultats de cette deuxième RT-PCR.
S’agissant des séquençages, les prélèvements doivent être orientés de la manière suivante :
- Les prélèvements réalisés sur des personnes de retour de l’étranger sont séquencés en priorité, uniquement s’ils n’ont pu faire l’objet d’un deuxième test RT-PCR réalisé avec un kit criblant les variantes, dans le réseau des laboratoires de biologie médicale disposant de la capacité de séquençage ou d’autres capacités de séquençage identifiées par les ARS et répondant au cahier des charges du CNR.
- Les prélèvements issus des personnes contaminées en clusters ou dans des zones présentant une augmentation forte et inexpliquée du TI sont orientés vers les laboratoires liés au réseau CNR-ANRS. Dans ces situations, l’envoi de 5 à 6 prélèvements avec un Ct <28 est nécessaire et suffisant, accompagné des renseignements clinico-épidémiologiques utiles tel que recommandé par le CNR (bon de demande disponible sur son site : https://www.pasteur.fr/fr/
sante-publique/centres- ) ; tout prélèvement non accompagné de ces renseignements ne sera pas techniqué.nationaux-reference/cnr/virus- infections-respiratoires-dont- grippe
Une attention particulière sera demandée :
- Aux laboratoires qui séquencent quant au transfert de la séquence au laboratoire prescripteur, qui saisira ensuite la séquence dans la base de donnée GISAID ;
- Aux laboratoires qui réalisent le test RT-PCR quant à l’inscription dans SI-DEP des résultats de séquençage qui leurs seront transmis par le laboratoire qui séquence.
Les kit Thermo Fisher pourront continuer d’être utilisées pour le diagnostic de première intention d’infection par le SARS-CoV2.
Dans tous les cas, le résultat du test de première intention doit déclencher les mesures de gestion individuelles sans retard. Il est impératif de ne pas attendre les résultats du test de criblage aux variantes pour lancer le processus de contact-tracing et d’isolement.
Compte-tenu d’une transmissibilité accrue des variantes le Haut Conseil de la Santé Publique a fait évoluer ses recommandations et Santé publique France a modifié la définition des contacts à risque :
- L’augmentation de la distance de sécurité entre 2 individus, qui passe de 1 mètre à 2 mètres (en l’absence de port du masque) ;
- Les masques grand public de catégorie 2 et les masques artisanaux ne sont plus recommandés pour se protéger de la contamination au SARS-CoV2 (le masque porté en population générale doit répondre à une norme de filtration élevée c’est-à-dire soit en tissu de catégorie 1 (AFNOR), soit de type chirurgical).
Les mesures de contact tracing qui en découlent doivent être renforcées dès le niveau 1:
- La notion de « contact à risque » doit être interprétée de manière large : en cas de doute dans l’évaluation du niveau de risque d’un contact, celui-ci doit être considéré comme « à risque » ;
- La mention par le cas de l’absence de contact à risque doit faire l’objet d’une investigation renforcée ;
- Le cas doit être invité à contacter ses contacts à risque pour les informer ;
- La chaîne de contamination doit être investiguée de manière plus extensive : les personnes contact à risque devront alerter leurs propres personnes contact afin de pouvoir mobiliser et sensibiliser deux niveaux de transmission potentielle à la nécessité de prendre des mesures de précaution.
Un résultat positif issu des kits RT-PCR spécifiques permet de suspecter un variant et déclencheront de manière prioritaire des actions de contact-tracing renforcées autour du cas par l’ARS et l’Assurance Maladie. Il ne nécessite pas systématiquement une confirmation par séquençage.
Nous vous remercions vivement de votre mobilisation, essentielle pour documenter et freiner la circulation éventuelle de ces variantes sur le territoire national.
Pr. Jérôme Salomon
Directeur Général de la Santé
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