Extension of French vaccination mandates: from the recommendation of the Steering Committee of the Citizen Consultation on Vaccination to the law.

On 4 December 2017, French parliamentarians passed a law extending the vaccination mandates for children up to 2 years of age from three vaccinations (against diphtheria, tetanus and poliomyelitis) to 11 by adding vaccinations against pertussis, Haemophilus influenza b (Hib), hepatitis B, pneumococcal diseases, meningococcal C diseases, measles, mumps and rubella. This vote follows a recommendation made by the Steering Committee of the Citizen Consultation on Vaccination that took place in 2016. The law applies to all children born after 1 January 2018. Parents who do not fulfil the mandate will not be fined but non-vaccinated children will not be admitted to any collective child services such as nurseries or schools. No exemption other than for medical reasons will be considered. Here we describe the historical background of this evolution and its main epidemiological, sociological and policy drivers. They mainly refer to insufficient vaccine coverage, persistence of a preventable burden for some diseases and growing vaccine hesitancy in the French population. We also discuss some of the challenges and conditions of success.

Réunion Island prepared for possible Zika virus emergence, 2016.

Zika virus (ZIKV) has recently spread widely and turned into a major international public health threat. Réunion appears to offer conditions particularly favourable to its emergence and therefore prepared to face possible introduction of the virus. We designed a scaled surveillance and response system with specific objectives, methods and measures for various epidemiological phases including a potential epidemic. Several tools were developed in order to (i) detect individual cases (including a large information campaign on the disease and suspicion criteria), (ii) monitor an outbreak through several complementary systems allowing to monitor trends in disease occurrence and geographic spread and (iii) detect severe forms of the disease in collaboration with hospital clinicians. We put the emphasis on detecting the first cases in order to contain the spread of the virus as much as possible and try to avoid progress towards an epidemic. Our two main strengths are a powerful vector control team, and a close collaboration between clinicians, virologists, epidemiologists, entomologists and public health authorities. Our planned surveillance system could be relevant to Europe and island settings threatened by Zika virus all over the world.

[France creates a national public health agency. Illustrations of its main missions and challenges]. / La France se dote d'une agence nationale de santé publique. Illustrations de ses principales missions et enjeux.

In 2016, France has established a national public health agency: "Santé publique France". Its missions are presented: epidemic intelligence, alert, surveillance, prevention and health promotion and response in the event of exceptional health situations.Four major challenges for this new agency are presented: the challenge of the continuum between its different public health functions in order to ensure the coherence of the merger of three public agencies ; The challenge of managing large databases; The challenge to give a new impetus to prevention - health promotion and finally the challenge of the presence of the Agency in all the metropolitan and overseas territories.

[Prevention and screening of HIV infection ]. / Prévention et dépistage de l'infection par le VIH.

The prevention of the HIV infection remains relevant considering the dynamics of the epidemic and the slackening of the preventive behavior of certain populations. The strategies associate initiatives of universal prevention: information, education, communication, screening; and specific actions in the direction of the most exposed populations. The paradigms of prevention evolved a lot these last years to take into account the preventive efficiency of antiretrovirals. If the condom remains the reference method, it is advisable for the populations the most exposed today to associate all the tools of prevention: behavioral methods, screening and antiretroviral. The possibility given to non-governmental organizations to realize test of fast screening allowed to go to closer of the most exposed populations.The arrival on the market of the autotests must be supervised to touch the people who do not turn to the screening.

[Prevention and child mental health: the ethical issues raised by targeted approaches]. / Prévention et santé mentale de l'enfant : les questions éthiques soulevées par des approches ciblées.

The details of the implementation of early prevention in child mental health in France have been at the heart of a debate between the defenders of a universal approach and the proponents of an approach targeting specific populations. The universal approach draws on various aspects of mother and child care and early childhood care offering considerate and expressive prevention based on a relationship of trust developed over time between professionals, parents and children. The targeted approach is based on the development of programs aimed at identifying vulnerable or at-risk populations. The ethical issues raised by targeted strategies are presented and discussed. The study highlights the difficulty of distinguishing between the social, educational, medical and psychological issues raised by early prevention.

[Quality assurance indicators for risk management in the follow-up of medical care received by acute ischemic stroke patients]. / Des indicateurs de qualité et de gestion des risques pour suivre la prise en charge hospitalière des accidents vasculaires cérébraux.

Although recommendations for diagnosis and treatment of stroke are available, the aim of this study was to identify indicators of quality and risk management for acute ischemic stroke hospital patients. We conducted a descriptive study of stroke patients who were diagnosed less than 12 hours before admission to the Pitié-Salpêtrière hospital's neurology and stroke unit. Data were collected using a literature review and from existing recommendation. During the study period (August 2003 through April 2005) 310 eligible patients were identified. In 87.5% of the cases, patients suffered from a cerebral infarction and in 10.3% from an intracranial haemorrhage. The initial deficit was mild to severe. The average time between the first symptoms and admission in the stroke unit was 212 +/- 130 minutes. Forty percent of patients who underwent a thrombolysis did so within the first 3 hours. The average length of stay in the stroke unit was 17.5 days. Thirty-one percent of the patients were discharged to go home, 47% to a rehabilitation unit and 8% died. Ten indicators of quality and risk management are proposed, taking in account the events before admission, hospital care, side effects, duration of stay, discharge location and the handicap.

[Medical and social characteristics and treatment plans for brain-damaged patients hospitalized]. / Caractéistiques médicales et sociales et trajectoires de soins des patients cérébro-lésés hospitalisés.

The study objective was to better understand the clinical and social characteristics, and the treatment plans, of brain-damaged patients who were hospitalized longer than one month in acute care units. A 6-month descriptive prospective epidemiological study of 90 patients was carried out. The average length of stay (LOS) was 84 +/- 73 days. Patients were severely disabled: 17.83% of patients showed a Glasgow Outcome Scale (GOS) 2, 70% a GOS 3 and 12.2%, a GOS > or =4. Two-thirds of the patients had social difficulties that influenced their LOS (68.4 days when social difficulties <3, versus 157.4 days when > or =3). An average of 4 rehabilitation settings were solicited per patient. The actual rehabilitation setting matched the patient's and team's wishes in only 63.4% of the cases. Several proposals are discussed to improve overall management of care for brain-damaged patients: the need to establish a mobile steering team, to improve multidisciplinary approaches, and to create acute physical medicine and rehabilitation units.

[The development of therapeutic education in France: current public policies and treatment options]. / Le développement de l'éducation thérapeutique en France: politiques publiques et offres de soins actuelles.

Therapeutic patient education (TPE) has significantly expanded in the last few years. This article explains the major trends underpinning and supporting its development in France, and how they have rendered it a central place in the system, and provided an integral role for therapeutic education within the wider perspective of medical care and treatment options. The organisation of TPE is analysed and numerous initiatives in hospitals, medical and health care structures, social centres, cities, and non-profit organisations are described. This analysis suggests a range of proposals in order to structure and integrate TPE in a sustainable manner for the long term, as well as to expand the existing initiatives to have a broader reach across the country.

[The development of therapeutic education in France: proposals for its sustainable integration in the health system]. / Le développement de l'éducation thérapeutique en France: propositions pour une intégration durable dans le système de soins.

The significant development of therapeutic patient education (TPE) in light of the current disparities observed in the organization of health care necessitates the consideration and delineation of proposals to better integrate TPE in the French health care setting and context in the long term. These proposals take into account the fundamental values of therapeutic patient education as well as the specificities of chronic disease management. They are based on actual examples from practice in medical structures that are recognized for the implementation of TPE activities and programmes: they aim at strengthening these through networking and at facilitating the work of all health professionals regardless of the methods of practice relative to the specific medical interventions they perform. These proposals aim to enrich current thinking on the organization, value and benefits of investing in TPE.