J.-P. Stahl

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.

Save antibiotics. What can be done to prevent a forecasted disaster! Suggestions to promote the development of new antibiotics.

New antibiotics are needed because of the increasing resistance of bacteria but they will be available in years to come only if drastic changes are implemented in development strategies, evaluation, use, and financing. Over the last decade, various opinions were stated and limited action was undertaken. Optimizing antibiotic use (as the antibiotic plan in France) was indispensable, but the process is still on going, and this is only part of the problem. Major questions are recurrently raised such as improvement of development procedures for new antibiotics, optimizing diagnostic methods, innovating financing modalities, or rescue of old antibiotics at risk of being withdrawn from the market. The symposium organized in September 2009 by the Swedish EU presidency helped to support previous recommendations. But conclusions remain unspecific. The propositions which are made here, after a work session, have for aim to be more detailed and innovating, even if they can be discussed, or even provocative.

Proposal for shorter antibiotic therapies

OBJECTIVESnReducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections.nnnMETHODSnAnalysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website.nnnRESULTSnThe shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables.nnnCONCLUSIONnThis work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.

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

Vaccination of pregnant women in France

OBJECTIVEnVaccination of pregnant women against seasonal influenza is recommended in France since 2010. We currently do not have any vaccination coverage (VC) data to assess the implementation of this recommendation.nnnMETHODSnVaccinoscopie® is an annual study conducted online using a self-administered questionnaire. A section dedicated to parents vaccination was included in 2014 and aimed at interviewing 300xa0mothers of infants aged<12xa0months to assess their opinion of vaccination with regard to their last and future pregnancies. The study also aimed to measure the influenza VC of these mothers during their last pregnancy.nnnRESULTSnWhile 56% of mothers reported to have been informed of the importance of vaccination by a healthcare professional (HCP) during their last pregnancy, only 11% reported having been informed of the importance of influenza vaccination. Overall, 49% of mothers reported willing to be vaccinated during their next pregnancy to protect their baby, if the vaccination were to be recommended by a HCP. However, this rate was only 32% for influenza vaccination. In contrast, 52% of mothers reported willing to be vaccinated against pertussis during pregnancy if the vaccination were to be recommended by a HCP. The influenza VC estimates in pregnant women was 7%.nnnCONCLUSIONnAlthough influenza vaccination has been recommended for all French pregnant women for the past five years, HCPs rarely recommend this vaccinationxa0-xa0hence, the low VC. Informing and raising awareness among HCPs seems to be crucial to improve this coverage.

Staphylococcus aureus nasal carriage during the infectious diseases national congress in France

OBJECTIVEnScreening for (methicillin-sensitive [MSSA] or -resistant [MRSA]) Staphylococcus aureus (SA) nasal carriage in health care workers in contact with fragile patients is a recurrent question. We wanted to assess carriage among infectious diseases healthcare workers.nnnMETHODSnVoluntary health care workers were recruited during the 2010 Yearly French Congress (Journées Nationales dInfectiologie, JNI). An anonymous double nasal swab was performed followed by PCR examination (GeneXpert MRSA/SA nasal tests) carried out on the Cepheid stand. Health care workers were also asked to fill in a questionnaire. Results were available 1 hour later but kept anonymous.nnnRESULTSnOne hundred and fifty-two tests and questionnaires were selected. MRSA was isolated from four health care workers (2.4%). MSSA was isolated from 52 health care workers (34.2%). Sex, clinical activity of health care workers, hospital size, and systematic screening of patients did not affect carriage.nnnCONCLUSIONSnThe prevalence of MSSA in nasal carriage in France is similar to the European one but the prevalence of MRSA is higher. This raises the question of a targeted decolonization in health care workers.

Pertussis vaccination coverage among French parents of infants after 10years of cocoon strategy.

OBJECTIVESnThe cocoon strategy against pertussis has been recommended in France since 2004 to indirectly protect young infants who are not yet vaccinated. We aimed to measure vaccination coverage among French parents of infants.nnnMETHODSnA representative sample of 300 mothers and 200 fathers of infants aged <12 months completed a self-administered online questionnaire. They all provided their own vaccination records.nnnRESULTSnOverall, 87% of mothers believed vaccination against pertussis to be important; 83% reported being immunized against pertussis but their vaccination records showed that a third of them was wrong (34%). On the basis of our sample, the 2009-2014 vaccination coverage against pertussis among mothers increased from 22 to 61% (P<0.005); over the same period of time, vaccination coverage against diphtheria, tetanus, and polio remained stable (80%). Vaccination coverage against pertussis among fathers increased from 21 to 42% between 2010 and 2013 (P=0.009). In 2013, one couple out of four (26%) was adequately immunized against pertussis.nnnCONCLUSIONnThe cocoon strategy was implemented 10years ago in France but vaccination coverage remains suboptimal among parents of young infants. Healthcare professionals must recommend vaccination against pertussis to young adults and check that their vaccination status is up to date.