E. Caulin

Does Monastic Life Predispose to the Risk of Saint Anthony’s Fire (Herpes Zoster)?

BACKGROUND The consequences of the epidemiology of varicella for zoster epidemiology are still debated. We therefore compared the frequency of herpes zoster in an adult population with virtually no varicella zoster virus (VZV) exposure with that in the general population (GP). METHODS We performed a national, multicenter, observational, exposed versus nonexposed, comparative study. The nonexposed population consisted of members of contemplative monastic orders (CMO) of the Roman Catholic Church living in 40 isolated monasteries in France. The exposed population consisted of a sample of the GP representative of the French population in terms of age group, sex, socio-occupational categories, and regions. RESULTS The primary analysis population comprised 920 members of CMO (41.5% nuns; mean age, 64.2 years) and 1533 members of the GP (51.9% women; mean age, 64.6 years). The reported frequency of zoster was 16.2% among CMO and 15.1% in the GP (P = .27, adjusted for sex and age). The reported mean age of onset of zoster was 54.8 and 48.6 years, respectively (P = .06). CONCLUSIONS This study failed to demonstrate an increased risk or earlier onset of zoster in members of CMO not exposed to VZV, compared with that in the GP. Although adults highly exposed to VZV could have a reduced risk of zoster, compared with the GP, our results suggest that the opposite is not true: adults not exposed to VZV are not at increased risk of zoster when compared with the GP, challenging the relevance of the assumptions and forecasts of current epidemiological models.

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.

Existe-t-il des différences d’immunogénicité et de tolérance des vaccins en fonction du mode d’injection ?

OBJECTIVE A literature review was made to answer the following question: are there differences in immunogenicity and safety of vaccines according to the administration route (intramuscular or subcutaneous) and the length of needles used for injection? DESIGN The search strategy included electronic searching (Medline database via PubMed) and cross-references. Articles were selected by reading abstracts, guided by the clinical question. A total of 18 articles were selected and analyzed; 13 answered the question. RESULTS Nine articles compared the immunogenicity and/or the safety of a given vaccine administered via both intramuscular and subcutaneous routes. All the results showed that immunogenicity and systemic safety of the intramuscular route was at least as good as that of the subcutaneous route. Local tolerance was usually better via intramuscular route (lower risk of developing erythema or edema). Four articles compared the immunogenicity and the safety of vaccines administered with short (16mm) and long (25mm) needles in children. Long needles induced fewer local reactions, probably because they can reach more vascularized muscle, especially in overweight and obese patients. CONCLUSIONS Immunogenicity and safety results are in favor of intramuscular vaccination. The appropriate needle length must to be adapted according to the morphological aspects (subcutaneous tissue and muscle thickness).

Étude épidémiologique prospective de la gastroentérite à rotavirus en Europe (étude REVEAL). Résultats de la zone d’étude française

PRIMARY OBJECTIVE To estimate the incidence of acute gastroenteritis (AGE) and rotavirus acute gastroenteritis (RVAGE) in children less than 5 years of age seeking medical care in primary care, emergency department, and hospital settings. SECONDARY OBJECTIVES To compare the clinical profile of RVAGE and non-RVAGE and to describe the distribution of RV serotypes among RVAGE cases. METHODS A prospective primary care, emergency ward and hospital-based observational study was conducted during 1 year in a selected city of France with 250,000 inhabitants. Children less than 5 years of age presenting with symptoms of AGE were included. Rotavirus was identified using an Elisa test in stools. RESULTS The estimated annual incidence of RVAGE was 1.56% for AGE and 0.87% for RVAGE in hospital, 5.87% for AGE and 2.65% for RVAGE in emergency-wards, 7.39% for AGE and 1.45% for RVAGE in primary care. Total incidence was 14.82% for AGE and 4.96% for RVAGE among children less than 5 years of age. RVAGE were more clinically severe than the AGE: dehydration (26.8% vs. 14.7%, p<0.0001), vomiting 84.9% vs. 60.9%, p<0.0001), fever (74.3% vs. 44.4%, p<0.0001), lethargy (84.9% vs. 70.2%, p<0.0001). G9 serotype was the most frequent serotype encountered (54.7%) during the study period followed by G3 serotype (33.6%) and G2 serotype (7.9%). CONCLUSION In this study, RVAGE, caused by serotypes G9 and G3, represented about 1/3 of AGE and were more severe than non-RV AGE with twice as high dehydration rate. These results underline the need for continued promotion on the use of oral rehydration fluids and provide some arguments on the benefits of vaccination against rotavirus and also permanent virological monitoring of circulating serotypes.

Evaluation of adult dTPaP vaccination coverage in France: experience in Lyon city, 2010–2011

BackgroundCompliance with official recommendations can be assessed by evaluating vaccination coverage (VC) in populations. The main objective of our study was to assess VC of adults against diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) according to age. The second objective was to explore if vaccination status could be confirmed by documentation.MethodsA cross-sectional study was conducted in 680 adults consulting for biological examination in private laboratories in Lyon (France) to evaluate VC for diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) and enabled reported vaccinations to be compared with documented, confirmed vaccinations.ResultsVerification of documented, confirmed vaccinations disclosed VC of 78.7% for tetanus, 63.6% for poliomyelitis, 57.8% for diphtheria and 10.7% for pertussis. Comparison of confirmed and self-reported vaccinations revealed that a large percentage of people who thought that they were vaccinated were not. VC significantly decreased with age for diphtheria and poliomyelitis and did not vary by gender. The VC rate for pertussis has increased since the 2008 recommendations were made.ConclusionsThe main thrust of this study was to compare reported and confirmed data. A significant percentage of people wrongly believed that they were up to date with their vaccination.

State of the art: Could nursing mothers be vaccinated with attenuated live virus vaccine?

Recently two cases of vaccine-associated neurologic disease have been reported in breastfed infants whose mothers had received live attenuated yellow fever vaccine. These two cases have focused attention on the transmission of attenuated yellow fever vaccine virus from mother to infant via breastfeeding, and more generally of all other live attenuated viruses used to immunize nursing mothers. This article provides an overview of the rare literature on possible virus excretion in breast milk after vaccination of nursing mothers with live attenuated virus vaccine and on cases of infection via breastfeeding in infants whose mothers had been vaccinated postpartum. Before implementing postpartum vaccination in a nursing mother, the vaccinator needs to weigh up the risk of transmission to and adverse effects in the baby from live vaccine virus against the beneficial effects of the vaccine for the mother, taking into account her need for vaccination.

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.

CL021 - Existe-t-il une association entre l’exposition au virus de la varicelle et la survenue d’un zona ? : Étude exposé - non exposé

Contexte – objectifs Des contacts repetes avec des enfants atteints de varicelle pourraient entretenir l’immunite contre le VZV et reduire le risque de zona a l’âge adulte. L’etude a pour but de comparer la frequence et l’âge de survenue du zona dans des populations presentant des niveaux d’expositions differents au virus de la varicelle. Methode Etude epidemiologique nationale, de type «exposes-non exposes » realisee par auto-questionnaire. Population non exposee : 920 moines et moniales vivants au sein de 40 monasteres isoles. Population exposee : echantillon representatif de la population francaise (1533 personnes). Population surexposee : 788 pediatres. Resultats la prevalence du zona etait de 16,2 % chez les moines et moniales, 15,1 % dans la population generale et 12,3 % chez les pediatres (p ajuste sur l’âge et le sexe : 0,59) L’âge moyen declare de survenue du zona etait respectivement, de la population la moins a celle la plus exposee de 54,8, 48,6 et 35,1 ans (p Conclusion il n’a pas ete mis en evidence dans cette etude d’association entre le niveau d’exposition au virus de VZV et le risque de developper un zona. Ces resultats suggerent que si l’exposition au virus VZV a un effet protecteur vis-a-vis de la survenue d’un zona chez l’adulte, l’effet doit etre faible.

SFP-P175 – Pathologie infectieuse – Hospitalisation pour varicelle avant l’âge d’un an

Objectifs Les enfants Methodes Entre mars 2003 et juin 2007,175 services de pediatrie ont declare 2675 cas, dont 76,4 % avaient une complication. Les donnees des enfants Resultats Les 745 cas Conclusion Chez les enfants hospitalises pour varicelle, les moins d’un an constituent le groupe d’âge le plus important. Cependant la maladie est moins compliquee avant 3 mois, probablement du fait des anticorps maternels transmis. Le role protecteur de l’aciclovir, tres prescrit, est mal defini dans cette population. Apres 3 mois et jusqu’a 1 an, les complications augmentent, particulierement les surinfections de la peau et des tissus mous.

SFP-03 – Pathologie infectieuse – AINS et varicelles hospitalisées : impact de la recommandation de l’AFSSAPS ?

Objectifs En juillet 2004, l’AFSSAPS a recommande de ne plus utiliser les AINS en cas de varicelle chez l’enfant du fait d’un risque potentiel de favoriser des complications infectieuses, en particulier cutanees. L’effet d’une telle recommandation a ete analyse au sein de la cohorte de patients inclus dans l’observatoire national des varicelles hospitalisees mis en place par le GPIP en collaboration ACTIV. Methodes De mars 2003 a juin 2007,175 services de pediatrie repartis sur l’ensemble du territoire francais ont rapporte 2675 cas de varicelles hospitalisees en decrivant les caracteristiques demographiques, les facteurs de risque, les complications et l’evolution a court terme. Resultats Les taux de surinfection et de surinfection cutanee sont signi-ficativement plus eleves en cas de prise d’AINS ; respectivement : 74,5 % versus 45,2 % (OR, 3,54 ; 95 % CI, 2,73-4,58, p = 0,0001) et 61,7 % versus 32,2 % (OR, 3,39 ; 95 % CI, 2,7-4,3, p Conclusion Depuis la recommandation de l’AFSSAPS, il a ete observe une baisse significative de l’utilisation des AINS en cas de varicelle compliquee hospitalisee. Par ailleurs, les surinfections cutanees ont diminue de maniere significative, mais un lien de causalite ne peut etre formellement demontre avec ces donnees et cette methodologie.