C. Pulcini

Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey

Our objectives were to describe the vaccine coverage (VC(1)) for some occupational vaccines (hepatitis B, pertussis, seasonal and pandemic influenza) among French General Practitioners (GPs(2)) and to study the factors associated with being vaccinated for each of these four diseases. We surveyed a representative national sample of 1431 self-employed GPs in France. Self-reported VC was 76.9% for 2009/10 seasonal influenza, 73.0% for hepatitis B, 63.9% for pertussis and 60.8% for A/H1N1 pandemic influenza. The factors associated with reporting being vaccinated were quite different from one vaccine to another. For some or all four vaccines, we found a significant positive association (p<0.05) with the following factors in the multivariate analysis: GPs male gender, high volume of activity, no particular mode of exercise (e.g. homoeopathy), no use of Internet at the practice, Continuing Medical Education sessions, discussing the benefits and risks of vaccination with the patients and performing prevention investigations for oneself (lipid profile). Being vaccinated for one vaccine also increased the VC for some or all three other studied vaccines. All these findings argue for public health campaigns using messages adapted to each vaccine.

E. coli CNF1 toxin: a two-in-one system for host-cell invasion

The cytotoxic necrotizing factor-1 (CNF1), a bacterial toxin of uropathogenic bacteria (UPEC), hijacks cellular Rho proteins of the Ras GTPase super-family. Recently, we have made three important findings. First, we have established that, following Rho protein activation by deamidation, these cellular proteins are ubiquitylated and degraded by the proteasome. Second, the low level of activated Rho proteins which results from the dual molecular mechanism of action of CNF1 (Rho protein activation followed by their degradation), confers high invasive properties to UPECs. Finally, we have reported that ubiquitylation and degradation of Rac is lost in HEp-2 carcinoma cells, thereby suggesting a possible link between Rho protein ubiquitylation and tumor progression.

Characteristics of patients and physicians correlated with regular influenza vaccination in patients treated for type 2 diabetes: a follow-up study from 2008 to 2011 in southeastern France

We studied a cohort of 110 823 patients treated with oral hypoglycaemic agents for type 2 diabetes in southeastern France from 1 January 2008 to 31 December 2011, to identify influenza vaccination coverage trends and the patient and physician correlates of influenza vaccine (IFV) uptake. We used French national health insurance fund (NHIF) databases to identify these patients and collect data on their IFV reimbursement claims (IFVC) and patient and physician characteristics. We used multilevel multivariate polytomous logistic regressions to test the correlates of IFVC. Between 2008 and 2011 the annual IFVC rate varied from 33.7% to 32.3% in the 18-64 age group and from 69.5% to 61.1% in the 65 + age group, among whom we saw a clear trend towards reduced vaccination after 2008. In the younger group, the probability of regular vaccination each year from 2008 to 2011 increased with diabetes severity and duration, comorbidities, and the number of general practitioner and nurse visits; it was higher among patients seeing endocrinologists and lower among low-income patients than in other patients. In the older group, there was no association with either diabetes severity or physician specialty. These results suggest different patterns of correlates of influenza vaccination according to age. Endocrinologists might help to improve IFV uptake in the younger group of patients with type 2 diabetes. Communication strategies regarding influenza vaccination should be adapted to age, and collaboration between healthcare professionals should be reinforced to achieve vaccination objectives for these patients.

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.

Opinions et pratiques d'un panel de medecins generalistes francais vis-a-vis de la vaccination.

En France, la couverture vaccinale est insuffisante. Les médecins généralistes étant des acteurs essentiels de la politique vaccinale, il est utile de connaître leurs opinions et pratiques à ce sujet. Nous avons interrogé 1431 médecins généralistes français et 98% se déclaraient favorables à la vaccination dans leur pratique quotidienne. Leurs couvertures vaccinales étaient de 73% pour l’hépatite B, 64% pour la coqueluche et 77% pour la grippe saisonnière. Les médecins se trouvaient très efficaces pour obtenir l’adhésion pour le vaccin ROR (Rougeole-Oreillons-Rubéole) chez les enfants de moins de deux ans et la grippe saisonnière chez les adultes de moins de 65 ans à risque, mais beaucoup moins pour l’hépatite B chez les adolescents. La mise en place d’un registre national informatisé des vaccinations et de messages de promotion vaccinale différenciés par vaccin semblent les deux voies prioritaires pour améliorer la couverture vaccinale.