[Which are somatic diseases of migrant children ?] / Quelles pathologies somatiques affectent les enfants migrants ?

WHICH ARE SOMATIC DISEASES OF MIGRANT CHILDREN? Migrant children form a vulnerable and heterogeneous population estimated at 70 000 in France. Their health is influenced by their living conditions in their home country, stress and exposure to pathogens, unsanitary housing and food insecurity during their migratory route and in their host country, as well as their parents psychological disorders. They present malnutrition, nutritional de¬ficiencies (iron and vitamin D), various dental, skin and intestinal infections, a significant prevalence of tuberculosis, and sometimes imported parasitic infections (malaria, schistosomiasis…) and lead poisoning. An high prevalence of early neurodevelopmental pro¬blems is noticed. Their immunity is insufficient and catch-up vacci¬nation is most often necessary. They require the support of a socio-psycho-medico-educational care network.

QUELLES PATHOLOGIES SOMATIQUES AFFECTENT LES ENFANTS MIGRANTS ? Les enfants migrants forment une population vulnérable et hétérogène estimée à 70 000 personnes en France. Leur état de santé est influencé par les conditions de vie dans leur pays d'origine, l'exposition aux stress et aux agents pathogènes, à l'insalubrité de leur hébergement et à l'insécurité alimentaire durant leur parcours migratoire et dans leur pays d'accueil, ainsi que par les troubles psychologiques parentaux. Ils présentent des malnutritions, des carences nutritionnelles (martiale et en vitamine D), des infections dentaires, cutanées et digestives, avec une prévalence significative de tuberculose, parfois des parasitoses importées (paludisme, bilharziose…) et du saturnisme. On observe une prévalence importante des troubles précoces du neurodéveloppement. Leur immunité vaccinale est insuffisante, et un rattrapage est le plus souvent nécessaire. Ils requièrent une prise en charge dans un réseau de soins socio-psycho-médico-éducatif.

Imported schistosomiasis in Paris region of France: A multicenter study of prevalence and diagnostic methods.

BACKGROUND: There are few data on imported schistosomiasis - especially in children. The objectives of the present study were to estimate the prevalence of imported schistosomiasis in at-risk children in the greater Paris region of France and to compare diagnostic methods. METHOD: Children at risk of schistosomiasis who consulted or were hospitalized in four hospitals in the greater Paris region were prospectively included. Clinical and laboratory data were collected. Urine and feces samples were screened for Schistosoma spp. using microscopy, a point-of-care circulating cathodic antigen and a real-time polymerase chain reaction assay. Serum samples were screened using Western blot, ELISA, indirect hemagglutination, and immunochromatographic assays. The diagnosis was characterized as confirmed (positive microscopy analysis) and as suspected (positive ELISA and Western blot assays). The prevalence of schistosomiasis and the tests' performances were estimated using the latent class method. RESULTS: A total of 114 children were included. Most of the children were newly arrived migrants from sub-Saharan Africa. The mean age was 13.2 years-old. There were 12 (10.5%) confirmed cases and 13 (11.4%) suspected cases. Half of the confirmed and suspected cases were asymptomatic. The prevalence was 24.3%. The ELISA and the Western blot assays presented the same sensitivity (83%) and specificity (99%). The serum immunochromatographic assay also showed good performance. CONCLUSIONS: The high prevalence of imported schistosomiasis among at-risk children in the greater Paris region confirms the need for systematic screening. A serum immunochromatographic assay appears to be one of the most effective screening methods for a low cost.

Tolerance and humoral immune response to the yellow fever vaccine in sickle cell disease children treated with hydroxyurea: a multicentre prospective study.

BACKGROUND: Sickle cell disease (SCD) children are frequent travellers to countries where yellow fever (YF) is endemic, but there are no data regarding the safety and immunogenicity of the vaccine in such children treated with hydroxyurea (HU). The main objective of this study was to compare the tolerance and immune response to YF vaccination in SCD children treated or not with HU. METHOD: SCD children < 18 years attending the international travel clinics of three large paediatric centres and requiring a first YF vaccination were included in a prospective study. Adverse events were collected 2 weeks after vaccination. YF vaccine antibody titres were measured ~6 months after vaccination. RESULTS: Among the 52 SCD children vaccinated against YF, 17 (33%) were treated with HU. Only mild adverse events, mainly fever and local reaction, were observed in the HU group with a similar frequency in the non-HU group (57 and 35%, respectively, P = 0.30). YF antibody titres were measured in 15/17 patients in the HU group and 23/35 patients in the non-HU group after a median of 6.0 months (3.5-8.5) following vaccination. The geometric mean of YF antibody titre was similar in both groups. A protective antibody level was observed in 85% of the children in the HU group vs 100% in the non-HU group (P = 0.14), suggesting a lower effectiveness of the vaccine in patients on HU similarly to what has been described in patients on immune suppressive therapy for other vaccines. CONCLUSION: YF vaccination seems to be safe and efficient in SCD children treated with HU. Considering the potential risk of severe complications in cases of YF while travelling in Africa for those patients, the benefit-to-risk ratio argues for YF vaccination in all SCD children. Control of a protective antibody titre may also be useful to ascertain an adequate response in those treated with HU.

Infections and nutritional status of internationally adopted children in France.

AIM: In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. METHODS: Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. RESULTS: Three hundred and fifty IACs [mean age: 3.4 years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety-nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P < .001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P = .02), while SN children were more often microcephalic or underweight (respectively P = .03 and .02). CONCLUSION: The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow-up.

Female genital mutilation: an evaluation of the knowledge of French general and specialized travel medicine practitioners.

We investigated the knowledge of female genital mutilation (FGM) among 60 general and 52 specialized travel medicine practitioners. Less than 50% of these practitioners had adequate knowledge of FGM. Only 42.9% declared having encountered FGM. FGM is likely underestimated in health facilities. Medical education and supporting information should be developed to better address and prevent FGM.

Children with chronic health disorders travelling to the tropics: a prospective observational study.

BACKGROUND: The number of trips to the tropics taken by children with chronic health disorders (CHDs) is increasing. METHODS: All of the children with CHDs who attended two international vaccination centres in France before travelling to the tropics were included in a prospective, exposed/unexposed study. Each child was age-matched with two control children and followed for 1 month after returning from the tropics. RESULTS: Fifty-six children with CHDs and 107 control children were included. The children's median age was 6 years old (IQR 2-11). Of the study participants, 127/163 (78%) travelled to West Africa, mainly to visit relatives. The median duration of the stay was 42 days (IQR 31-55). The age of the children, the destination and the duration of the trip were similar between the two groups. Sickle cell disease (23/56) and asthma (16/56) were the most common CHDs. Overall, the children with CHDs experienced more clinical events than the control patients did (p<0.05); however, there was no difference when chronic disease exacerbations were excluded (p=0.64) or when only the period abroad was considered (p=0.24). One child with a recent genetic diagnosis of atypical haemolytic uraemic syndrome died from a first disease exacerbation. CONCLUSIONS: Health problems among children with CHDs travelling abroad are mainly related to chronic disease exacerbations, which mostly occur after the children return. Patients with diseases that require highly specialised care for an exacerbation should avoid travelling to resource-limited tropical countries.

[Hepatitis C virus screening in drug users in an addiction out-patient unit]. / Prise en charge de l'infection par le virus de l'hépatite C dans une population de toxicomanes suivis dans un centre spécialisé ambulatoire.

AIM: To investigate the feasibility and efficacy of hepatitis C virus screening in drug users in an addiction out-patient unit. PATIENTS AND METHODS: All patients followed in an addiction out-patient unit were asked to undergo anti-hepatitis C virus antibody testing; further evaluation and treatment if indicated, were offered to positive patients. When treatment was initiated (Metavir score >=F2), patients were followed-up both by the hepatologist and the out-patient unit physician. RESULTS: Between July 1997 and September 2000, 404 consecutive patients (310 men, mean age: 32, alcohol intake >=50 g per day in 51%, 94% in opiate substitution program) were included. Sixty-six per cent (269/404) of patients agreed to undergo HCV antibodies testing: 84% had a positive test. 68% of these patients accepted ALT serum measurement and 120 had indications for liver biopsy. Eighty-eight liver biopsies were performed, showing severe fibrosis (Metavir score F3 or F4) in 20 cases (22%). Ethanol intake was significantly correlated to fibrosis (P<0.05). Antiviral treatment was indicated in 47 patients but was only initiated in 27 due to patient refusal (n=7) or contraindication (n=13). Treatment had to be discontinued in 12 cases because of psychiatric side effects (depression: n=3; delirium: n=3; severe irritability: n=3; relapse with heroin injection: n=3). Finally, only 5 patients were sustained responders. CONCLUSION: Despite the high seroprevalence of HCV antibodies in this unit, the benefits of antiviral therapy are low due to high drop out rate. Ethanol withdrawal should be the highest priority in these patients.