[Albert Calmette: celebrating the 150th anniversary of his birth]. / Albert Calmette : à propos du 150e anniversaire de sa naissance.

Albert Calmette (1863-1933) left a major legacy, ranging from basic research to practical medical applications. His initial work focused on antivenimous serum therapy, as well as the creation of Pasteur Institutes outside France. But his greatest achievement is the discovery of the BCG vaccine, in conjunction with Camille Guerin. This was a major advance at a time when tuberculosis was a veritable scourge, responsible for the deaths of thousands of children each year. He also pioneered early TB control in the field. The validity of BCG vaccination was not called into question despite the Lubeck drama, that he bravely affronted in 1931.

[Pediatric emergency care in pediatric hospitals in France]. / Les urgences en pédiatrie dans les hôpitaux d'enfants.

Emergency medicine has evolved considerably over the last 25 years in France, driven by major sociological and epidemiological upheavals, and is now a high-level and academic specialty. Pediatric emergency units were originally modeled on adult emergency services and now meet the same efficiency criteria. However, the reduction in care supply, together with the simultaneous increase in demand, has created significant deficiencies. This is particularly true in pediatric teaching hospitals, which deal with the highest volume of patients but are subject to cost-cutting and eficiency measures. The main problems are the lack of flow management upstream and inadequate hospital capacity downstream. Solutions have been proposed to mitigate these issues but more efforts are needed.

[Vaccine refusal and implications for public health in 2012]. / Le refus des vaccinations. Aspects actuels en 2012 et solutions en santé publique.

Public opposition to vaccination is growing in all western countries, resulting in poor vaccine coverage and failure, as exemplified by measles in Europe. Opposition to vaccination ranges from radical refusal to hesitation, negligence or omission. The fear of adverse effects is now stronger than the fear of infectious diseases. The benefits of vaccination for vanishing infectious diseases can be hard to perceive. Safety alerts, false messages spread by the media and internet, and mistrust of experts also play a part. Studies consistently show that parents of children who are inadequately vaccinated or not vaccinated at all suffer from a lack of reliable information. More information on vaccines is needed, especially on the risk-benefit ratio. Doctors and other healthcare professionals need better training in vaccines, infectious diseases and epidemiology; and college students must receive better scientific education if they are to understand public health messages. Free, compulsory or recommended vaccination, and changes in vaccine schedules, cannot alone overcome vaccine refusal. In France, better coordination is needed among the institutions responsible for vaccination. The growing influence of the media and internet calls for international reflection on how to limit the spread of false information on vaccines.

[Consequences of opposition to vaccination in France and Europe. How to maintain effective vaccine coverage in 2010?]. / Conséquences des oppositions vaccinales en France et en Europe. Comment maintenir une couverture vaccinale efficace en 2010?

Refusal of vaccination can result in inadequate vaccine coverage. The collective benefit of immunisation depends on a sufficient and sustained level of vaccine coverage. Low vaccine coverage can lead to the persistence of preventable diseases and, in some cases, to a dangerous shift in the age of pathogen encounter towards adulthood. This is the case of measles in Europe, where some countries, including France, have not reached the effective vaccine coverage rate of 95%. Outbreaks are occurring, leading to complications (encephalitis and pneumonia) in adolescents and adults, necessitating hospitalization in nearly one-third of cases. The French population is also under-vaccinated against hepatitis B, due to fears of a risk of demyelinating disorders: the coverage rate is currently only about 30% in infants and 10% in adolescents. These difficulties are due to negligence and to vaccine refusal by parents. Refusal of immunisation has a long history in Europe, and explains for example why pertussis remained endemic in many countries until 1995, and also the resurgence of diphtheria in the Russian federation during the 1990s. Sections of Western society are now questioning the need for some routine vaccines, overlooking the fact that they have eradicated some diseases (polio, diphtheria, etc.) and protect effectively against lesser-known pathogens such as hepatitis B virus and HPV. In France, it will be necessary to restructure healthcare professional training programs in vaccinology and to provide the public with more thorough information on the risk-benefit ratio of vaccination. The recent controversy surrounding pandemic H1N1 influenza vaccination demonstrates that the public and the media tend to focus more on the potential risks of vaccination than on its benefits. A vigorous ethical and political debate is needed to shape an effective and acceptable vaccine policy for the 21st century.

[Sickle cell disease in France in 2008. Achievements and challenges]. / La drépanocytose en France en 2008. Les acquis et les nécessités du futur.

Much progress has been made in the past two decades in the diagnosis and management of sickle-cell disease. Clinical, pathophysiological and therapeutic studies have given rise to national procedures for all patients. Life expectancy has improved dramatically in industrialized countries, and the number of sickle-cell patients reaching adulthood is growing. Neonatal diagnosis began in France in 1995 and is crucial for early prevention. Crisis management and long-term surveillance both require dedicated drepanocytosis centers for children and for adults.

[Vaccination against human papillomavirus. Implementation and efficacy against cervical cancer control]. / Les vaccins des papillomavirus humains. Leur place dans la prévention du cancer du col utérin.

The two new HPV vaccines (Gardasil quadrivalent and Cervarix bivalent 16,11) are both effective against HPV types 16 and 18, which are responsible for 70% of cervical cancers, and the quadrivalent vaccine is effective against HPV 6 and 11, responsible for genital warts. Their efficacy is 100% if they are administered before exposure to HPV 16,18. The proven duration of protection against high-grade cervical lesions is currently 5 years, and the need for boosters is unknown. Cervical cancer screening programs must continue, as only 70% of the 15 high-risk HPV types are targeted. The best age for primary vaccination appears to be 11-12 or 14 years, before the outset of sexual activity. Vaccination of older women is less efficacious, and vaccination of males is being discussed. HPV vaccines should be useful in developing countries, if they can be made available. HPV vaccination campaigns require adequate public information.

[Sickle cell disease in childhood in 2004]. / La drépanocytose chez l'enfant en 2004.

Sickle cell disease is a genetic autosomal recessive disease of hemoglobin. The disease results from a mutation of the sixth codon of the beta-globin gene, which induces the synthesis of an abnormal hemoglobin called hemoglobin S (HbS). The polymerisation of deoxy HbS molecules causes a chronic hemolytic anemia and vaso-occlusive phenomena. The disease affects mainly people from West Indies and Sub Saharan Africa. Due to recent movements of these populations over the past years, sickle cell disease has spread across all continents. Painful crises, severe infections such as septicemia, meningitis, osteomyelytis, acute anemia episodes, and severe vaso-occlusive events, mainly neurological, are the most frequent complications affecting children. Recent progresses in the care of patients have deeply modified the prognosis. The mean life expectancy of patients is now above 40 years. The conventional treatment includes antibiotics and immunizations, analgesics, and blood transfusion. The effects of chronic blood transfusion, hydroxyurea and bone marrow transplantation are the subject of current comparative evaluations.

[What vaccination has brought]. / Ce que la vaccination a apporté.

The vaccines have improved obviously and constantly the struggle against infectious diseases. When the immunisations have been well applied some diseases fell down dramatically: i.e. diphtheria, poliomyelitis and smallpox which was eradicated. Actually some efficacious vaccines as measles or rubella vaccines could eliminate the diseases. Nevertheless in many developed countries the immunisation coverage is not properly reached and the diseases are always circulating, with a shift of age towards adults, with more severe diseases or new epidemiology (i.e. pertussis). However measles have been eliminated from some countries as Finland, Sweden, United States. The adverse events of vaccines are nowadays enhanced and discourage immunisation among some doctors or patients. The benefit-risk ratio has to be made very clear to avoid a lack or a denial of immunisation after false fears about risk of some vaccines. An improvement of surveillance and of correct information is highly required.