Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy.

OBJECTIVES: The vaccine schedule was changed in 2013 in France, which resulted in fewer vaccinations. However, to maintain disease protection, both vaccine timeliness and high coverage should be respected. In the context of growing vaccine hesitancy, we aimed to describe compliance with the immunization program according to the age recommended for each dose for non-preterm children less than 2 years old. METHODS: Between May 2013 and April 2016, we used automated electronic data capture of electronic medical records for non-preterm children less than 2 years old. Children were followed up by 92 randomly selected pediatricians from the French ambulatory pediatricians group. Delayed immunization was defined as more than 15 days after the recommended age for the primary series of diphtheria-tetanus-pertussis-polio-Haemophilus influenzae b-hepatitis B (DTaP-IPV-Hib±HB) and 13-valent pneumococcal vaccine (PCV13), 2 months for boosters, 1 month for measles-mumps-rubella (MMR)/meningococcal C conjugate (Men-C), and 6 months for the second dose of MMR. An association between delayed first dose and other doses delayed were described with odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Data for 22,097 children in France with 124,702 vaccinations were analyzed: 21.8%, 20.4%, and 30.7% of children had one or more delayed doses of DTaP-IPV-Hib±HB, PCV13, and MMR vaccines, respectively. For 47.6% of children, the single-dose Men-C vaccination was delayed. A delayed first dose of DTaP-IPV-Hib±HB, PCV13, and MMR was associated with a delayed second dose of the same vaccine (OR 7.5 [95% CI 6.6-8.6], 39.0 [34.1-44.8], and 23.5 [19.1-29.0], respectively) and with a third dose of DTaP-IPV-Hib±HB and PCV13 (14.7 [13.3-17.7] and 3.7 [3.1-4.5]). CONCLUSION: This large study shows that the proportion of children with delayed vaccination in France was globally high and substantial for Men-C and the first MMR vaccination. Risk of a delayed second and third dose was increased with a delayed first dose, which may reflect vaccine hesitancy.

Pertussis vaccination coverage among adults in the Lyon area.

BACKGROUND: The compliance with recommendations for Pertussis vaccination was assessed in the Lyon population through vaccination coverage (VC). METHODS: A cross-sectional study was conducted in collaboration with 10 private biological analysis laboratories between October 2010 and March 2012, on 1930 adults (>19 years of age) from the Lyon area. Proof of vaccination (PV) was requested to prove the current vaccination status. RESULTS: A percentage of 30.3% (585/1930) of surveyed individuals provided a PV. A positive vaccination status was confirmed in 10.76% [CI 95% 8.45-13.48] (63/585) and didn't vary in relation to gender (P=0.57), age (P=0.06), or level of schooling (P=0.41). Coverage vaccination was not updated in parents with childbearing project (84.2% (64/76) [CI 95% 74.7-91.2]) or people in contact with children less than 6 years of age (83.6% (87/104) [CI 95% 75.6-89.8]). Pertussis vaccination wasn't confirmed in 80.0% (124/155) of those who thought being vaccine up to date. CONCLUSIONS: The Lyon population poorly complied with the cocooning strategy implemented in 2004. The pertussis vaccine coverage confirmed by a PV proved the inadequate rate of vaccination compared to objectives. It is mandatory to strengthen the vaccinal policy for this vaccine booster.

Survey of vaccination policies in French healthcare institutions.

OBJECTIVE: The survey was implemented to describe vaccination policies for healthcare professionals in French healthcare institutions. METHODS: A cross-sectional survey based on questionnaires was sent to occupational physicians and chairpersons of hospital infection prevention and control committees (HIPC) of 38 institutions between November 2010 and January 2011. RESULTS: Twenty-nine occupational physicians and 26 hospital infection prevention and control committees chairpersons (HIPC), from 30 institutions answered (response rate: 79%), 70% of the institutions were university hospitals. Overall, 76% of occupational physicians and 85% of HIPC chairpersons reported that information and awareness campaigns about vaccination recommendations for healthcare professionals were usually conducted in their establishment. Fifty-nine percent of occupational physicians and 31% of HIPC chairpersons reported that they were aware of the vaccine coverage rates of professionals in their institution. The occupational physicians reported that they suggested diphtheria, tetanus, polio, influenza, and acellular pertussis vaccination to all staff at their annual visit in 100%, 97%, and 62% of cases, respectively. Varicella and measles vaccinations were never suggested in 31% and 17% of cases, respectively. Among respondents, 55% of physicians reported that they had already managed a pertussis epidemic, and 42% a measles epidemic, and in both of these cases an awareness campaigns were usually conducted (93% and 96%). CONCLUSIONS: The vaccine coverage rates of healthcare professionals in French healthcare institutions remain insufficiently documented and could be improved.

[Sensitivity and specificity of the VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux) and the ELISA IDEIA Rotavirus kit (Dako) compared to genotyping]. / Sensibilité et spécificité du test immuno-chromatographique VIKIA Rota-Adéno (bioMérieux) et du kit Elisa IDEIA Rotavirus (Dako) par rapport aux techniques de génotypage.

The performances of two diagnostic tests for rotavirus infection in stool samples were evaluated during a prospective study in children of less than 36 months in child-care centers of Lyon from November 2004 to May 2005. The VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux) and the ELISA IDEIA Rotavirus kit (Dako) were compared with a referral method, the genotyping. Fifty-seven stool samples were collected and analyzed by RT-PCR. The virus genome was detected in 29 samples. The most frequent genotypic combinations were G9P[8] with a prevalence of 75.9%. Sensitivity and specificity of the VIKIA Rota-Adeno test and the ELISA IDEIA Rotavirus kit were strictly comparable and very good: 96.6% (83.0; 99.9) and 96.4% (81.6; 99.9), respectively. The immuno-chromatographic technique were in concordance with the ELISA tests in 93.6% of cases. Thus, the VIKIA Rota-Adeno test is a good alternative for the occasional analysis of stool samples in ambulatory practice.

[Assessment of workload in pediatric emergency units due to acute gastroenteritis during the epidemic season in France]. / Evaluation de la charge de travail induite aux urgences pédiatriques par les gastroentérites aiguës en période épidémique.

OBJECTIVE: The aim of this study was to assess the burden of medical and paramedical activities related to the management of acute gastroenteritis (AGE) cases in France. METHODS: An observational, multicenter study was carried out in 23 French pediatric emergency units. Each unit was requested to include the first 25 children less than five years of age, consulting for AGE during the epidemic season. RESULTS: A total of 443 children was included between January and April 2007. The median age was 13 months. Symptoms had been persisting for an average of 2.7 days, and 60.7% of patients had already consulted. In 62.6% of cases, oral rehydration solution (ORS) had been prescribed. The median waiting time in the EU was 15 minutes. The median time spent by a health care professional with a child was 55 minutes (30 minutes for paramedical care and 25 minutes for medical care). The length of these visits increased significantly (p<0.0001) if children presented with signs of dehydration or behavioral changes. The child's age had no significant impact. Rehydration in the EU was 70% oral rehydration, 16% parenteral rehydration (8% were combined). Among the children, 37% were discharged after consultation in the EU, 39% after observation, and 24% were hospitalized. 90% of the children who were given a prescription on discharge were prescribed at least one ORS (n=333). CONCLUSION: The time spent by a health care professional with a child presenting with acute gastroenteritis could cause organizational problems during an epidemic outbreak.

[Are there differences in immunogenicity and safety of vaccines according to the injection method?]. / Existe-t-il des différences d'immunogénicité et de tolérance des vaccins en fonction du mode d'injection ?

OBJECTIVE: A literature review was made to answer the following question: are there differences in immunogenicity and safety of vaccines according to the administration route (intramuscular or subcutaneous) and the length of needles used for injection? DESIGN: The search strategy included electronic searching (Medline database via PubMed) and cross-references. Articles were selected by reading abstracts, guided by the clinical question. A total of 18 articles were selected and analyzed; 13 answered the question. RESULTS: Nine articles compared the immunogenicity and/or the safety of a given vaccine administered via both intramuscular and subcutaneous routes. All the results showed that immunogenicity and systemic safety of the intramuscular route was at least as good as that of the subcutaneous route. Local tolerance was usually better via intramuscular route (lower risk of developing erythema or edema). Four articles compared the immunogenicity and the safety of vaccines administered with short (16mm) and long (25mm) needles in children. Long needles induced fewer local reactions, probably because they can reach more vascularized muscle, especially in overweight and obese patients. CONCLUSIONS: Immunogenicity and safety results are in favor of intramuscular vaccination. The appropriate needle length must to be adapted according to the morphological aspects (subcutaneous tissue and muscle thickness).

[Epidemiology and burden of rotavirus diarrhea in day care centers in Lyon, France]. / Epidémiologie et impact de la gastroentérite aiguë à rotavirus dans les crèches municipales de la ville de Lyon - saison 2004-2005.

Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24 h period, a fecal specimen was tested by Elisa test IDEIA Rotavirus (Dako) and the immunochromatographic test VIKIA Rota-Adeno (BioMérieux). Sequencing by RT-PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT-PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4-3.0] per 100 child-months in children aged less than 36 months of age, increasing to 3.4 per 100 child-months among children aged less than 24 months. Vomiting (P<0.0005) and behavior modification (P<0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54 euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France.

[Prospective epidemiological study of rotavirus gastroenteritis in Europe (REVEAL study). Results in the French area of the study]. / Etude épidémiologique prospective de la gastroentérite à rotavirus en Europe (étude REVEAL). Résultats de la zone d'étude française.

PRIMARY OBJECTIVE: To estimate the incidence of acute gastroenteritis (AGE) and rotavirus acute gastroenteritis (RVAGE) in children less than 5 years of age seeking medical care in primary care, emergency department, and hospital settings. SECONDARY OBJECTIVES: To compare the clinical profile of RVAGE and non-RVAGE and to describe the distribution of RV serotypes among RVAGE cases. METHODS: A prospective primary care, emergency ward and hospital-based observational study was conducted during 1 year in a selected city of France with 250,000 inhabitants. Children less than 5 years of age presenting with symptoms of AGE were included. Rotavirus was identified using an Elisa test in stools. RESULTS: The estimated annual incidence of RVAGE was 1.56% for AGE and 0.87% for RVAGE in hospital, 5.87% for AGE and 2.65% for RVAGE in emergency-wards, 7.39% for AGE and 1.45% for RVAGE in primary care. Total incidence was 14.82% for AGE and 4.96% for RVAGE among children less than 5 years of age. RVAGE were more clinically severe than the AGE: dehydration (26.8% vs. 14.7%, p<0.0001), vomiting 84.9% vs. 60.9%, p<0.0001), fever (74.3% vs. 44.4%, p<0.0001), lethargy (84.9% vs. 70.2%, p<0.0001). G9 serotype was the most frequent serotype encountered (54.7%) during the study period followed by G3 serotype (33.6%) and G2 serotype (7.9%). CONCLUSION: In this study, RVAGE, caused by serotypes G9 and G3, represented about 1/3 of AGE and were more severe than non-RV AGE with twice as high dehydration rate. These results underline the need for continued promotion on the use of oral rehydration fluids and provide some arguments on the benefits of vaccination against rotavirus and also permanent virological monitoring of circulating serotypes.

[Frequency and clinical characteristics of rotavirus acute gastroenteritis in children under 5 years of age treated in community practice in France]. / Place et caractéristiques cliniques des gastroentérites aiguës à rotavirus chez les enfants de moins de cinq ans suivis en médecine de ville en France. Etude ROTASCORE.

OBJECTIVES: The primary objective of this study was to determine the proportion of cases of gastro-enteritis due to rotavirus in children under 5 years of age consulting community physicians. A secondary objective was to compare the clinical characteristics of children with and without rotavirus acute gastro-enteritis (RV AGE). METHODS: Multicentre, prospective, observational study conducted between December 2005 and May 2006. Each practitioner included 10 consecutive patients presenting with acute gastro-enteritis (AGE). RESULTS: 601 community practitioners, chiefly paediatricians (74.7%), included 5,062 children, 4,383 (86.6%) of whom were evaluable for analysis. The children's median age was 14 months. A rapid detection test (VIKIA((R)) Rota-Adeno - Laboratoires Biomérieux) was performed in 4,178 (95.3%) children and was rotavirus-positive in 43.7% of cases. More than 85% of children presenting with RV AGE were more than 6 months old. The difference between the severity scores of children in whom a rotavirus was detected and those in whom it was not detected was statistically significant (P<0.0001). Rotavirus AGE was significantly different (P<0.0001) from rotavirus-negative AGE in respect of vomiting (78.3% vs 51.0%), fever (76.0 vs 49.4%), weight loss (69.0 vs 43.2%), presence of signs of dehydratation (15.6 vs 3.7%) and behavioural disorders (44.4 vs 36.2%). Hospitalisation was proposed in 5.1% of cases (9.1 vs 1.8%; P<0.0001). CONCLUSION: In this population of children under 5 years of age treated on an outpatient basis, the rapid detection test revealed the presence of rotavirus in 43.7% of cases. RV AGE appears to be significantly more severe and more often hospitalised.

[Awareness and application of vaccine recommendations for chickenpox in French Nurse Schools]. / Connaissance et application des recommandations vaccinales concernant la varicelle en institut de soins infirmiers en France.

Since 2004, the French High Committee on Public Hygiene has recommended chickenpox vaccination for first-year medical or paramedical students with no history of chickenpox and with negative serology. A survey was carried out among directors of nurse schools to evaluate both their awareness of these new recommendations and the way in which they had been applied. A questionnaire was sent by mail to each of the directors of the 332 nurse schools identified throughout France. Less than half (41%) of the 147 directors who responded said they were aware of recommendations, and 31% stated they had real knowledge of the recommendations. Only 21% enquire about chickenpox history of students enrolling in their school, and 9% undertake serological assessment of students with no known history of varicella or zoster. More needs to be done both to inform nurse school directors of the vaccine recommendations and to ensure their application.

Seroprevalence of varicella antibodies among pregnant women in Lyon-France.

The purpose of the study was to calculate the seroprevalence of immunity to the varicella-zoster virus (VZV) infection and to evaluate the positive predictive value (PPV) and the negative predictive value (NPV) of the self-reported history of VZV infection in pregnant women. A cross sectional study was conducted in 18 private medical analysis laboratories. Information on socio-demographic characteristics and past history of varicella or zoster were collected using a questionnaire. Blood samples were obtained to determine the serological levels of past exposure to VZV. Overall, 486 pregnant women were recruited. The seroprevalence of VZV antibodies was 98.8%. Six women were seronegative, of whom four were primiparous. The PPV was high (99.5%) while the NPV was only 10.3%. The PPV is a reliable marker of prior VZV infection. In contrast, a negative history does not predict lack of immunity and should be completed by serological analysis which might be introduced to routine antenatal blood tests.

Paediatric varicella hospitalisations in France: a nationwide survey.

Paediatric patients hospitalised with varicella (n = 1575) were reported to a French national network between March 2003 and July 2005. Superinfection was identified in 50.3% of cases, principally of skin and soft-tissue (36.5%). The risk of superinfection increased with fever relapse, use of non-steroidal anti-inflammatory drugs, prolonged fever, an age of 1-5 years, and contamination at the childminder's home. Neurological complications were observed in 7.8% of cases, while pulmonary complications were less frequent (3.1%). Forty-nine patients had sequelae and eight patients died. Surveillance should continue in France with a view to the future implementation of a universal vaccination programme.

[Management of intussusception in France in 2004: investigation of the Paediatric Infectious Diseases Group, the French Group of Paediatric Emergency and Reanimation, and the French Society of Paediatric Surgery]. / Modalités de prise en charge des invaginations intestinales aiguës en France en 2004: enquête commune du Groupe de pathologie infectieuse pédiatrique (GPIP), du Groupe francophone d'urgences et de réanimation pédiatrique (GFRUP) et de la Société française de chirurgie pédiatrique (SFCP).

OBJECTIVES: To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. MATERIAL AND METHODS: A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. RESULTS: One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). CONCLUSION: The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.

[Efficacy and safety of pristinamycin vs amoxicillin in community acquired pneumonia in adults]. / Essai comparatif de l'efficacité et de la tolérance de la pristinamycine vs amoxicilline dans le traitement des pneumonies aiguës communautaires de l'adulte.

STUDY OBJECTIVE: Evaluation of efficacy and safety of pristinamycin (PRI), compared with amoxicillin (AMX), both at 3 g daily for 7 to 10 days in adults with community-acquired pneumonia (CAP). PATIENTS AND METHODS: Multinational, randomized, double blind, double dummy clinical trial of non-inferiority was conducted in 399 patients with a CAP. RESULTS: At inclusion, the mean age was 47.8+/-18.3 years, 24.3% patients were 65 or older. The Fine score was < or =III in 85.4% patients. The bacterial etiology was documented in 34.8% of patients: Streptococcus pneumoniae (48.1%), Mycoplasma pneumoniae (18.6%), Haemophilus influenzae (14.7%), Chlamydia pneumoniae (13.2%), Legionella pneumophila (9.3%). In the clinical per-protocol population, the clinical success rate was 87.6% in each group: 149/170 patients (PRI) and 148/169 (AMX); The 95% confidence interval was [-6.61%; 7.23%]. In modified intend to treat population, the clinical success rate was 79.9% (151/189) in the PRI group and 83.0% (151/182) in the AMX group [CI 95% (-10.87%; 4.69%)]. A satisfactory bacteriological response was observed in 82.3% (51/62) of PRI patients and 88.1% (59/67) of AMX patients. Treatment related adverse events occurred similarly in both groups according to the expected tolerance profile of the two drugs. No serious adverse events in both groups were related to the study drugs. CONCLUSIONS: In this study, PRI 3 g daily was clinically as effective and well tolerated as AMX 3 g daily, for 7 to 10 days, in PPc, in the treatment of bacterial community-acquired pneumonia.

Resistance to amikacin and isepamicin in rabbits with experimental endocarditis of an aac(6')-Ib-bearing strain of Klebsiella pneumoniae susceptible in vitro.

The effect of production of the aminoglycoside 6'-N-acetyltransferase [AAC(6')-IB] in Klebsiella pneumoniae on the outcome of amikacin and isepamicin treatment of rabbits with experimental endocarditis was assessed. Isogenic high-level (Hi) and low-level (Lo) AAC(6')-Ib-producing transconjugants (T) were constructed from clinical isolates with plasmid-borne resistance determinants. The MICs of amikacin and isepamicin, their bactericidal effects, and AAC(6')-Ib production appeared to be well correlated among the clinical isolates and the transconjugants. The susceptibility data determined in vitro, with MICs (in micrograms per milliliter) of amikacin and isepamicin for LoT and HiT of 4 and 0.5 and 32 and 8, respectively, were, however, not predictive of the in vivo efficacies of the drugs. While amikacin and isepamicin caused reductions in bacterial densities (log10 CFU per gram of cardiac vegetation) of 5.1 and 4.8 of the fully susceptible recipient strain (MICs of amikacin and isepamicin, 0.5 and 0.25, respectively), the reductions in density of both LoT and HiT caused by the two drugs (2.7 and 2.4 and 2.9 and 2.2, respectively) were only marginally significant, if at all. There was no significant difference (P > 0.05) when the reductions in density of LoT and HiT by either drug were compared or when the efficacies of the two drugs in reducing the density of any strain [non-AAC(6')-producing, LoT, or HiT] were compared (P > 0.5). It is concluded that AAC(6')-Ib in K.pneumoniae, even when produced at a low level and not conferring resistance to amikacin and isepamicin in vitro, compromises the efficacies of both drugs in vivo and possibly does so beyond the experimental model studied here.