G. Picherot

Kinetics of Decline of Maternal Measles Virus-Neutralizing Antibodies in Sera of Infants in France in 2006

ABSTRACT The optimal age for measles vaccination is an important health issue, since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops, while delaying vaccination may increase the risk of complicated diseases in infants. However, measles vaccination impacts the duration of protection afforded by transplacental transfer of maternal antibodies: vaccination-induced maternal antibodies disappear faster than disease-induced antibodies. In order to maintain protection against measles in infants, it is important to monitor the dynamics of this phenomenon in vaccinated populations. To assess the current situation in France, a multicenter, prospective seroepidemiological study was conducted in seven French hospitals between October 2005 and January 2007. Maternal measles antibody concentrations from 348 infants 0 to 15 months old were measured using the plaque reduction neutralization assay. Geometric mean concentrations and the percentage of infants with maternal measles antibody concentrations above the protection threshold (≥120 mIU/ml) were assessed according to age. Results show that after more than 20 years of routine measles vaccination in France, maternal measles-neutralizing antibodies decrease dramatically in French infants by 6 months of age, from 1,740 mIU/ml for infants 0 to 1 month old to 223 mIU/ml for infants 5 to 6 months old, and that 90% of infants are not protected against measles after 6 months of age. Infant protection against measles could be optimized both by increasing herd immunity through an increased vaccine coverage and by lowering the age of routine vaccination from 12 to 9 months.

Prevalence of Anti-Varicella-Zoster Virus Antibodies in French Infants under 15 Months of Age

ABSTRACT Varicella is a widespread disease of childhood resulting from primary infection with varicella-zoster virus (VZV). The objective of this study was to determine the kinetics of the decline of maternal anti-VZV antibodies in French infants between birth and the age of 15 months in order to estimate the duration of passively acquired maternal anti-VZV immunoglobulin G (IgG). This prospective multicenter study was conducted between October 2005 and January 2007 in the pediatric wards and/or pediatric emergency units of seven French hospitals scattered throughout the country. The level of anti-VZV IgG antibodies in serum was measured by a time-resolved fluorescence immunoassay (TRFIA) (the threshold considered positive is 150 mIU/ml). A total of 345 infants were included. Seventy-seven percent of mothers reported a history of varicella. A rapid decline in the prevalence of anti-VZV antibodies was observed during the first few months of life, with the mean antibody titer decreasing from 536 mIU/ml at birth and through 1 month to below the 150-mIU/ml threshold at 3 to 4 months. The half-life of passively acquired maternal immunoglobulins was around 6 weeks. Based on a large number of subjects, this study clearly demonstrated, for the first time in France, high levels of passively acquired maternal antibodies during the neonatal period, and it allowed us to estimate the duration of passively acquired maternal anti-VZV IgG in French infants. After 4 to 5 months, infants had very low levels of maternal anti-VZV IgG, below the 150-mIU/ml cutoff of the VZV IgG TRFIA.

Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis.

We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.

Contribution of procalcitonin to occult bacteraemia detection in children

We conducted a prospective study in 215 children, 3 to 36 months of age, presenting with fever ≥39°C without obvious origin, in order to evaluate the diagnostic value of procalcitonin (PCT) in detection of occult bacteraemia. PCT associated with white blood cell count constitutes an efficient screening method with sensitivity 100%, specificity 61.9% and positive and negative likelihoods ratios of 2.62 and 0, respectively

Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an : actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO)

BACKGROUND AND OBJECTIVES While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants. METHOD Pediatricians, pediatric pulmonologists, and emergency physicians of the Grand Ouest University Hospitals (France) gathered to analyze the recent data from the literature. RESULTS Criteria to distinguish childhood asthma from acute viral bronchiolitis were established, then prescriptions of diagnostic tests, antibiotics, and chest physiotherapy were defined and reserved for very limited situations. Similarly, the modalities of oxygen therapy prescription and nutritional support were proposed. Finally, other therapeutics such as nebulized hypertonic saline seem promising, but their place in the treatment of acute bronchiolitis in infants remains unclear. CONCLUSION This work has provided new proposals for management of acute viral bronchiolitis and helped standardize practices within the Grand Ouest University Hospitals. This local organization could lay the keystone for working toward guidelines initiated by learned societies at the national level.

Distribution of serum measles-neutralizing antibodies according to age in women of childbearing age in France in 2005-2006: impact of routine immunization.

Measles antibody titers were measured in 210 French women. Ninety-four percent had protective values (>120 mIU/mL). Geometric mean titers were significantly different (P < 0.001) between women born before and after 1983, when measles vaccination was recommended (731 and 1358 mIU/mL, respectively). geometric mean titers in 4 age cohorts decreased significantly (P < 0.001) with increasing birth year. These data may help identify the appropriate age for infant vaccination.

L’alcoolisation des adolescents : une précocité inquiétante ?

Age of first drink in France and Western countries is early. National and international surveys confirm this early onset. Drunkenness, which is the most obvious drinking outcome, seems to rise amongst young adolescents. Consequences of this precocity are considerable. At short-term, drunk teenagers are more frequently victims of accidents. In addition, they are more vulnerable to sexual abuses, as victims but also as perpetrators. At medium- and long-terms, the early development of alcohol use is linked to higher levels of later drinking dependence. Three explanatory ways for this precocity are developed: familys influence, role of advertising and media, and role of peers. When alcohol meets adolescence, it is sometimes a real storm. Prevention is uneasy because of the very commonplace of alcohol at home. It can concern family level or society level. As for tobacco, society intervention is needed to delay age of first drink and limit teenager alcohol use but this should not involved adolescents condemnation.

Frequency and Characteristics of Infectious Diseases in Internationally Adopted Children: A Retrospective Study in Nantes From 2010 to 2012

BACKGROUND AND AIMS Internationally adopted children are more susceptible to developing and carrying acute or chronic infectious diseases. Specialized consultations exist in the main French cities; however, specialized consultation with a pediatrician is not mandatory. The main objective of this study was to determine the frequency and characteristics of infections (bacterial, viral, and parasitic) among a group of international adoptees in Nantes over a 3-year period. METHODS A retrospective chart review was conducted of internationally adopted children who went through the Medical Guidance for Adopted Children Consultation between 2010 and 2012. RESULTS A total of 133 children were included in the study. Of these, 55% had an infectious disease; 8% were severe infections. We found a frequency of 38% [confidence interval (CI) 95% 30-46] for parasitic intestinal and 35% (CI 95% 27-43) for dermatologic infections. African children were more likely to have infections that required hospitalization [odds ratio (OR) = 12, p = 0.004, CI 95% 1.3-113.7] and more likely to carry extended-spectrum β-lactamase-producing bacteria. CONCLUSION The frequency of infectious diseases, and sometimes severe diseases, found among our cohort of internationally adopted children highlights the need for systematic, specialized medical care.

SFP-02 – Pathologie infectieuse – Utilisation de la procalcitonine (PCT) aux urgences pédiatriques ; nécessité d’une prescription ciblée

La procalcitonine est un marqueur d’infection bacterienne maintenant valide chez l’adulte comme chez l’enfant. Son dosage fait depuis l’objet de nombreuses prescriptions puisqu’il est prescrit chez 10 % des enfants consultant dans notre service. Objectif Montrer le manque de performance de ce marqueur lorsqu’il est prescrit sans distinction dans toutes les situations de suspicions d’infections bacteriennes de l’enfant. Patients et Methodes Analyse retrospective d’une cohorte d’enfants ayant fait l’objet d’un dosage de PCT lors d’une consultation aux urgences pediatriques sur une periode de 2 mois. Les patients ont ete classes en 7 categories d’infections bacteriennes selon des definitions validees dans la litterature (Pyelonephrites, meningites,ORL,digestif,respiratoire,fievre isolee, syndrome grippal). Ont ete etablies des courbes ROC puis calcules la sensibilite, specificite et le rapport de vraisemblance (RV) de la PCT. Le seuil pathologique retenu etait 0.5 ng/ml Resultats 273 dossiers ont ete analyses. Toutes indications confondues, l’aire sous la courbe de la courbe ROC de la PCT est inferieure a celle de la CRP (0.75 ± 0.06 vs 0.81 ± 0.05 respectivement). L’association des 2 marqueurs par une analyse discriminante n’est pas plus performante que la CRP seule (0.82 ± 0.05 vs 0.81 ± 0.05). On retrouve pourtant de bonnes sensibilite, specificite et rapport de vraisemblance + en cas de fievre isolee : 100 ± 40%, 65.7 ± 14 % et 4.85 (IC 95 % : 3.04-7.7) respectivement, et de meningite : 100 ± 33 % et 100 ± 40 % respectivement. Ces parametres sont tres peu performants par contre en cas d’infections ORL ou digestives avec une sensibilite de 36 ± 22 et 40 ± 32%, une specificite de 73 ± 20 et 68 ± 14 % et un RV + de1.33 (IC95 % : 0.44-4) et 1.26 (IC95 % : 0.39-4.08) respectivement. A posteriori,42 % des prescriptions de PCT pour cette cohorte n’etaient pas justifiees. Conclusion La realisation d’un dosage de PCT doit etre reservee aux situations ou ce marqueur est connu comme discriminant. La prescription doit en etre ciblee et seniorisee afin d’eviter des derives d’utilisation deleteres pour tous.

Maltreatment and Adolescence

All forms of abuse are observed in teenagers: physical, sexual, psychological, and neglect. The reader will find some topics more specific to adolescence, such as maltreatment and ICT (information and communication technology) as well as so-called indirect warning signs. Understanding the indirect signs is fundamental to recognizing abuse in teenagers. These include suicide attempts, running away, malaise, eating disorders, and acts of violence.