J. Gaudelus

Transmission of bordetella pertussis to Young Infants

Background: Pertussis vaccination has reduced the number of notified cases in industrialized countries from peak years by more than 95%. The effect of recently recommended adult and adolescent vaccination strategies on infant pertussis depends, in part, on the proportion of infants infected by adults and adolescents. This proportion, however, remains unclear, because studies have not been able to determine the source case for 47%–60% of infant cases. Methods: A prospective international multicenter study was conducted of laboratory confirmed infant pertussis cases (aged ≤6 months) and their household and nonhousehold contacts. Comprehensive diagnostic evaluation (including PCR and serology) was performed on all participants independent of symptoms. Source cases were identified and described by relationship to the infant, age and household status. Results: The study population comprised 95 index cases and 404 contacts. The source of pertussis was identified for 48% of infants in the primary analysis and up to 78% in sensitivity analyses. In the primary analysis, parents accounted for 55% of source cases, followed by siblings (16%), aunts/uncles (10%), friends/cousins (10%), grandparents (6%) and part-time caretakers (2%). The distribution of source cases was robust to sensitivity analyses. Conclusions: This study provides solid evidence that among infants for whom a source case was identified, household members were responsible for 76%–83% of transmission of Bordetella pertussis to this high-risk group. Vaccination of adolescents and adults in close contact with young infants may thus eliminate a substantial proportion of infant pertussis if high coverage rates can be achieved.

Bacillus Calmette-guérin infection after vaccination of human immunodeficiency virus-infected children

The use of Mycobacterium bovis/Bacillus Calmette-Guérin (BCG) to vaccinate against tuberculosis remains controversial. The development of tuberculosis in human immunodeficiency virus (HIV)-infected children demands specific evaluation of the risk/benefit ratio of BCG vaccination in this situation. In our institution 9 of 68 HIV-infected children vaccinated with BCG before the diagnosis of HIV infection was suspected developed vaccine-related complications: 7 of these children had a large satellite adenopathy with or without skin fistulae, whereas the other 2 had disseminated BCG infection beyond the satellite ganglion (involvement of the spleen and mesenteric and mediastinal lymph nodes in one case and the liver and lungs in the

Vaccinoscopie® : étude de l’évolution annuelle entre 2008 et 2011 de la couverture vaccinale des enfants de moins de 7 ans dans la population française

UNLABELLEDnAssessing vaccination coverage (VC) is a critical part of adherence to immunization guidelines and beyond vaccine effectiveness can fill possible gaps and optimize VC. The aim of this study was to measure annual VC trends (2008-2011) among children 0-6years of age.nnnMETHODSnAn Internet survey was conducted using a self-administrated questionnaire to a representative sample (quota method) of mothers reporting their childs immunization record.nnnRESULTSnDiphtheria-tetanus-poliomyelitis-pertussis VC (complete schedule) was 96.0% at 6 years of age in 2010. Hepatitis B VC (≥1 dose) in the 6- to 11-month-old population increased from 54.6% in 2008 to 80.5% in 2011, but only 34.7% of 6-year-old had received a complete schedule in 2010. Pneumococcal conjugate vaccine VC (complete schedule) increased to 92.7% in the 24- to 35-month-old population. Measles-mumps-rubella (MMR) VC (2 injections) increased in 24- to 35-month-olds from 60.3% in 2008 to 81.0% in 2011. In 2011, 64.2% of 24- to 35-month-olds had received a second dose of MMR vaccine before 25 months vs. 45.4% in 2008. BCG VC in 12- to 35-month-olds was 73.2% in Île-de-France, where vaccination is recommended in all children vs. 15.5% elsewhere (vaccination only recommended in high-risk children).nnnCONCLUSIONnThis study shows a significant improvement of VC in young French children. However, outreach efforts should continue to be made, especially to adolescent and adult populations, in whom VC is very low.

Interferon-gamma release assay performance for diagnosing tuberculosis disease in 0- to 5-year-old children.

QuantiFERON-TB Gold In-Tube performance was evaluated in 19 French immunocompetent children (0.29–5.36 years; median: 1.52) with active tuberculosis. The rate of indeterminates results was 0/19 and the rates of positivity were 6/10 and 9/9 in <2 and 2- to 5-year-old children, respectively. QuantiFERON-TB Gold In-Tube in association with tuberculin skin test could improve diagnosis of tuberculosis even in young children.

Mémoire originalVaccinoscopie® : étude de l’évolution annuelle entre 2008 et 2011 de la couverture vaccinale des enfants de moins de 7 ans dans la population françaiseAnnual trends (2008–2011) in early childhood vaccination coverage for the French population: The Vaccinoscopie® study

UNLABELLEDnAssessing vaccination coverage (VC) is a critical part of adherence to immunization guidelines and beyond vaccine effectiveness can fill possible gaps and optimize VC. The aim of this study was to measure annual VC trends (2008-2011) among children 0-6years of age.nnnMETHODSnAn Internet survey was conducted using a self-administrated questionnaire to a representative sample (quota method) of mothers reporting their childs immunization record.nnnRESULTSnDiphtheria-tetanus-poliomyelitis-pertussis VC (complete schedule) was 96.0% at 6 years of age in 2010. Hepatitis B VC (≥1 dose) in the 6- to 11-month-old population increased from 54.6% in 2008 to 80.5% in 2011, but only 34.7% of 6-year-old had received a complete schedule in 2010. Pneumococcal conjugate vaccine VC (complete schedule) increased to 92.7% in the 24- to 35-month-old population. Measles-mumps-rubella (MMR) VC (2 injections) increased in 24- to 35-month-olds from 60.3% in 2008 to 81.0% in 2011. In 2011, 64.2% of 24- to 35-month-olds had received a second dose of MMR vaccine before 25 months vs. 45.4% in 2008. BCG VC in 12- to 35-month-olds was 73.2% in Île-de-France, where vaccination is recommended in all children vs. 15.5% elsewhere (vaccination only recommended in high-risk children).nnnCONCLUSIONnThis study shows a significant improvement of VC in young French children. However, outreach efforts should continue to be made, especially to adolescent and adult populations, in whom VC is very low.

Vaccination against meningococcus C. vaccinal coverage in the French target population

UNLABELLEDnImmunization against meningococcus C has been recommended in France since 2009 (infants from 12 to 24 months of age, and catch up vaccination up to 25 years of age). It has been reimbursed since January 2010. We had for aim to assess the vaccine coverage in 2011.nnnMETHODnThe study population included mothers of children targeted by the recommendation. They were recruited using Internet data (quotas based on the French National Institute of Statistics (INSEE) data based on a census made in 2007) based on the Institut des Mamans panel and its partners. The mothers had completed a standardized questionnaire and reported all vaccinations mentioned in their childs health-record.nnnRESULTSnWe included 3000 mothers of children, 0 to 35 months of age, (1000 for each of the following age range: 0-11 months, 12-23 months, 24-35 months), and 2250 mothers of teenagers, 14 to 16 years of age. Vaccination was deemed essential/useful for respectively 90.2% (CI 95%: 89.2-91.3) and 87.8% (CI 95%: 86.4-89.2) of mothers. Vaccine coverage levels were 32.3% (12-23 months), 57.3% (24-35 months), and 21.3% (14-16 years).nnnCOMMENTSnTwo years after the Ministry of Healths decision to reimburse this vaccine, vaccine coverage levels were much lower than they should have been, to expect effectiveness of the vaccination policy. Only 21.3% of teenagers had been vaccinated, and 32.3% of infants during the second year of life.

The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy

OBJECTIVEnVaccine hesitancy is a growing and threatening trend, increasing the risk of disease outbreaks and potentially defeating health authorities strategies. We aimed to describe the significant role of social networks and the Internet on vaccine hesitancy, and more generally on vaccine attitudes and behaviors.nnnMETHODSnPresentation and discussion of lessons learnt from: (i) the monitoring and analysis of web and social network contents on vaccination; (ii) the tracking of Google search terms used by web users; (iii) the analysis of Google search suggestions related to vaccination; (iv) results from the Vaccinoscopie(©) study, online annual surveys of representative samples of 6500 to 10,000 French mothers, monitoring vaccine behaviors and attitude of French parents as well as vaccination coverage of their children, since 2008; and (v) various studies published in the scientific literature.nnnRESULTSnSocial networks and the web play a major role in disseminating information about vaccination. They have modified the vaccination decision-making process and, more generally, the doctor/patient relationship. The Internet may fuel controversial issues related to vaccination and durably impact public opinion, but it may also provide new tools to fight against vaccine hesitancy.nnnCONCLUSIONnVaccine hesitancy should be fought on the Internet battlefield, and for this purpose, communication strategies should take into account new threats and opportunities offered by the web and social networks.

Épidémiologie de la tuberculose en France

Resume La tuberculose reste une des causes les plus frequentes de deces par maladie infectieuse dans le monde. La lutte contre la tuberculose est une priorite pour lOrganisation mondiale de la sante. Un tiers de la population mondiale est infecte par le bacille de Koch avec 8 millions de nouveaux cas par an et 2 millions de deces annuels. En Europe, pres de 400 000 nouveaux cas ont ete en 2001 declares avec un gradient ouestest pour le taux dincidence : 11 cas pour 100 000 dans les pays dEurope de louest, 41 pour 100 000 pour les pays dEurope centrale et 92 pour 100 000 pour les pays dEurope de lest. Le nombre de cas de tuberculose a diminue en France entre 1972 et 1988 avec une decroissance reguliere dincidence denviron 7 % par an. Apres une stabilisation en 1989, lincidence a augmente. Cet « excesde cas est en partie lie a linfection par le VIH mais aussi a la degradation des conditions socioeconomiques. Entre 1993 et 1997, le taux dincidence a de nouveau diminue et est actuellement stable a 11 pour 100 000 en France metropolitaine. En 2002, 6322 cas de tuberculose ont ete declares en France. Il existe dimportantes differences geographiques. La region Ile-de-France a le taux dincidence le plus eleve: 27,1 pour 100 000. Le taux dincidence des autres regions est beaucoup plus faible. Le risque dinfection varie selon lâge, le sexe et la nationalite. Les sujets de plus de 75 ans sont les plus touches. Les enfants de moins de 15 ans representent 4,3 %, et la moitie des cas est observee avant 5 ans. Comme chez ladulte, le taux dincidence de tuberculose est 11 fois plus eleve chez les enfants migrants que chez les enfants de nationalite francaise. Moins de 10 cas de meningite tuberculose sont declares annuellement chez lenfant de moins de 15 ans. Depuis 2003 la declaration obligatoire inclut la tuberculose infection. Les donnees recueillies devraient aider a ameliorer le controle de la tuberculose en France.

Papillomavirus vaccination in France according to 2008 to 2012 Vaccinoscopie(®) data.

UNLABELLEDnVaccination against human papillomavirus infections (HPV), introduced in the French vaccinal schedule in 2007, was recommended until the end of 2012 for 14-year-old girls, with a catch-up policy until 23years of age. We followed the evolution of this vaccine coverage rate (VC) during these 5years in the Vaccinoscopie(®) survey.nnnMETHODnWe present the analysis of data collected in 2012 from a sample of 1136 mothers of girls 14 to 16years of age. They answered a self-administered questionnaire on Internet and reported all vaccinations mentioned in their daughters health record.nnnRESULTSnIn 2012, respectively 12.9%, 33.6%, and 48.1% of girls 14, 15 and 16years of age had begun HPV vaccination (≥1 dose received) and respectively 4.3%, 23.6%, and 40.5% of them had received a complete vaccination schedule (3 doses), i.e. 31.7% of 14-16-year-old girls had started the vaccination schedule and 22.9% were fully vaccinated. VC for ≥1 dose had decreased between 2009 and 2012 (-14 points in 14-year-old girls, -16 points in 15-year-old girls, and -11 points between 2009 and 2012 in 16-year-old girls). Regional VCs were heterogeneous.nnnCONCLUSIONnHPV VC is clearly insufficient. It is essential that physicians concerned by HPV vaccination be mobilized and take every opportunity to inform, reassure, and vaccinate teenage girls. HPV vaccination has been recommended for girls between 11 and 14years of age since 2013, which could help improve adherence to vaccination.

Hepatitis B vaccination and adolescents: A lost generation.

a b v a b 2 f i v i a r o t Hepatitis B (HepB) is a potentially severe infectious disease ecause of its associated morbidity (risk of progression to cirhosis and/or hepatocellular carcinoma) and mortality rate. With n estimated 280,000 chronic carriers of the HBs antigen, 2300 o 3700 newly diagnosed patients with acute HepB, and 1500 eaths every year in France, HepB represents a public health hallenge [1]. Preventing the infection is therefore crucial. In France, HepB vaccination policy relies on two strategies: accinating individuals at high risk of exposure, regardless of heir age, and vaccinating infants with a catch-up vaccination or children and adolescents aged < 15 years to implement a ong-term control of the infection [2]. All unvaccinated children r adolescents aged under 16 years should, therefore, be offered epB vaccination when consulting a family physician (FP). Every year since 2008, the Vaccinoscopie® study collects ata from the medical records of a sample of adolescents aged 14 nd 15 years (627 to 1500 adolescents depending on the year). ollected data allows for an evaluation of vaccination coverage nd for monitoring that coverage over the years [3]. With regard o HepB vaccination coverage, the results of the Vaccinoscopie® tudy highlights the failure of the HepB catch-up vaccination espite the introduction of a simplified vaccination schedule in 009: two doses administered to adolescents aged between 11 nd 15 years. In 2014, only one adolescent in two aged 14–15 ears (51.3%; 95% CI: 48.2–54.4) received at least one dose of he HepB vaccine and slightly less than a third (32.5%; 95% I: 29.6–35.4) completed the full vaccine series (Fig. 1). Vacination coverage for HepB has remained the same since 2008. nalyzing the patient’s age at administration confirms that the accine catch-up was almost never administered to that popuation. Only 7.3% (95% CI: 5–9.5) of adolescents aged 14–15 ears received the first dose of the HepB vaccine between the ge of 11 and 15 years. The lack of improvement in terms B m c