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.

Fetal heart rate patterns at 20 to 24 weeks gestation as recorded by fetal electrocardiography.

INTRODUCTION: With advancing technology it has become possible to accurately record and assess fetal heart rate (FHR) patterns from gestations as early as 20 weeks. The aim of our study was to describe early patterns of FHR, as recorded by transabdominal fetal electrocardiogram according to the Dawes-Redman criteria. Accordingly, short-term variability, basal heart rate, accelerations and decelerations were quantified at 20-24 weeks gestation among women with uncomplicated pregnancies. METHODS: This study was conducted in a subset of participants enrolled in a large prospective pregnancy cohort study. Our final data set consisted of 281 recordings of women with good perinatal outcomes who had undergone fetal electrocardiographic assessment as part of the Safe Passage Study. RESULTS: The success rate of the recordings was 95.4%. The mean frequency of small and large accelerations was 0.5 and 0.1 per 10 min, respectively and that of small and large decelerations 0.3 and 0.008 per 10 min, respectively. The mean and basal heart rates were both equal to 148.0 bpm at a median gestation of 161 days. The mean short term variation was 6.2 (SD 1.4) ms and mean minute range 35.1 (SD 7.1) ms. CONCLUSION: The 20-24-week fetus demonstrates FHR patterns with more accelerations and decelerations, as well as higher baseline variability than was anticipated. Information from this study provides an important foundation for further, more detailed, studies of early FHR patterns.

Adverse effects of trichothiodystrophy DNA repair and transcription gene disorder on human fetal development.

The effects of DNA repair and transcription gene abnormalities in human pre-natal life have never been studied. Trichothiodystrophy (TTD) is a rare (affected frequency of 10(-6)) recessive disorder caused by mutations in genes involved in nucleotide excision repair (NER) pathway and in transcription. Based on our novel clinical observations, we conducted a genetic epidemiologic study to investigate gestational outcomes associated with TTD. We compared pregnancies resulting in TTD-affected offspring (n = 24) with respect to abnormalities during their antenatal and neonatal periods to pregnancies resulting in their unaffected siblings (n = 18), accounting for correlation, and to population reference values. Significantly higher incidence of several severe gestational complications was noted in TTD-affected pregnancies. Small for gestational age (SGA) <10th percentile [Relative risk (RR ) = 9.3, 95% CI = 1.4-60.5, p = 0.02], SGA <3rd percentile (RR = 7.2, 95% CI = 1.1-48.1, p = 0.04), and neonatal intensive care unit (NICU) hospitalization (RR = 6.4, 95% CI = 1.4-29.5, p = 0.02) occurred more frequently among TTD-affected neonates compared with their unaffected siblings. Compared with reference values from general obstetrical population, pregnancies that resulted in TTD-affected infants were significantly more likely to be complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome (RR = 35.7, 95% CI = 7.6-92.5, p = 0.0002), elevated mid-trimester maternal serum human chorionic gonadotropin (hCG) levels (RR = 14.3, 95% CI = 7.0-16.6, p < 0.0001), SGA <3rd percentile (RR = 13.9, 95% CI = 7.4-21.1, p < 0.0001), pre-term delivery (<32 weeks) (RR = 12.0, 95% CI = 4.9-21.6, p < 0.0001), pre-eclampsia (RR = 4.0, 95% CI = 1.6-7.4, p = 0.006), and decreased fetal movement (RR = 3.3, 95% CI = 1.6-5.2, p = 0.0018). Abnormal placental development is an underlying mechanism that may explain the constellation of observed complications in our study. Thus, we hypothesize that TTD DNA repair and transcription genes play an important role in normal human placental development.

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.

The risk of hospital-acquired GB virus C infection: a pilot case-control study.

The risk of hospital-acquired infection with GB virus C (GBV-C) was explored among 42 patients. The factors independently associated with detection of GBV-C RNA in serum were bronchoscopic examination [adjusted odds ratio (OR)=18.1 (95% confidence interval 1.3-255.3), P=0.03] and a history of illicit drug use [OR=14.5 (1.0-218.7), P=0.05]. In this cohort of patients, invasive procedures appear to be associated with GBV-C infection but not with hepatitis C virus (HCV) infection.

Rubella.

Rubella, also known as German measles or three-day measles, is a self-limited, mild viral illness that poses little danger to children or adults. For the developing fetus, however, infection with rubella virus is a grave threat, capable of inducing severe anomalies and permanent disability. Despite widespread vaccination programs, populations of susceptible individuals persist, among them women of childbearing age whose pregnancies remain vulnerable to congenital rubella syndrome. In the United States, the currently used rubella vaccine employs live-attenuated virus and is contraindicated in pregnancy. Nonpregnant women receiving rubella vaccination should be advised to use effective contraception for 3 months after inoculation. These warnings persist despite the fact that no clinically significant case of congenital rubella syndrome after maternal vaccination has been reported. Obstetrician/gynecologists must be familiar with rubella and the management of pregnancies complicated by exposure to the disease. Furthermore, practitioners must actively seek and vaccinate susceptible individuals to minimize this significant threat to public health.

Rubeola.

Rubeola, more commonly known as the "red measles" or "10-day measles," is a highly contagious exanthematous viral illness. Although most cases end with full recovery, rare but serious, even fatal sequelae such as encephalitis and pneumonia can occur. The incidence of measles worldwide has decreased dramatically since the introduction of effective vaccines. Nevertheless, outbreaks still occur among clusters of individuals, especially young adults, that vaccination programs have failed to reach. Susceptible young women are at unique risk because measles in pregnancy follows a more complicated course than in nonpregnant adults. Furthermore, pregnancies complicated by rubeola are more likely to end with spontaneous abortion or preterm delivery. In the United States, the currently used rubeola vaccine employs live-attenuated virus and is contraindicated in pregnancy. Nonpregnant women receiving rubeola vaccination should be advised to use effective contraception for 3 months after inoculation. These warnings persist despite the fact that an adverse pregnancy outcome after maternal measles vaccination has not been reported. Obstetrician/gynecologists must be familiar with rubeola and the management of pregnancies complicated by exposure to the disease. Furthermore, practitioners must actively seek and vaccinate susceptible individuals to minimize this ongoing threat to public health.

Second-trimester vaginal bleeding: correlation of ultrasonographic findings with perinatal outcome.

OBJECTIVE: Our purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding. STUDY DESIGN: A retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks' gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. RESULTS: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0.036), as was history of two or more previous preterm deliveries (6% vs none, p = 0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. CONCLUSION: Second-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.

The effect of beta blocking drugs on lipid peroxidation in rat heart in vitro.

Beta-adrenergic receptor blocking drugs include a structurally related class of drugs that are employed clinically to treat a variety of cardiovascular disorders. Since these drugs exert additional nonspecific effects including membrane stabilization, representative samples including atenolol, dilevolol, labetalol, metoprolol and propranolol were studied to determine their influence on lipid peroxidation. Homogenates or liposomes of adult rat hearts were incubated in the presence of various concentrations of propranolol or equivalent concentrations of dilevolol, labetalol, metoprolol or atenolol. Lipid peroxidation was stimulated with 50 microM FeSO4, 5 microM t-butyl hydroperoxide (homogenates) or 0.2 mM citrate FeSO4 (liposomes) plus O2. Lipid peroxidation, as assessed by both the thiobarbituric acid reaction and chemiluminescence, was reduced in a dose-dependent manner as the propranolol concentration was increased from 1 to 10 mM. The five beta-adrenergic receptor blocking drugs reduced lipid peroxidation both in crude homogenates and in liposomes; their effectiveness was related to their lipophilicity. Dilevolol, propranolol, labetalol and metoprolol at a concentration of 20 mM reduced lipid peroxidation by 45%, 37%, 35% and 28%, respectively. The hydrophilic blocker atenolol was ineffective in reducing lipid peroxidation even at elevated concentrations. Lipophilic beta-blocking drugs apparently are capable of exerting an antioxidant effect in protecting membrane lipids against peroxidation.