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Wang Q, Nacher M, Tosi A, Clarke L, Rwagitinywa J, Alsibai KD, Castor MJ. Coverage of BCG Vaccination for children aged until 7 years old and its determinants in French Guiana. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202381. [PMID: 38579396 DOI: 10.1016/j.jeph.2024.202381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The overall incidence of tuberculosis (TB) in France is low; thus, BCG vaccination is no longer mandatory. In French Guiana - a French overseas territory - BCG vaccination is strongly recommended because the incidence of TB is high in the context of mass immigration from endemic countries with low BCG vaccination rates. Thus, it is important to assess Bacillus Calmette-Guérin (BCG) vaccination coverage and its predictors. METHODS We used data from the 2014 French Guiana Yellow Fever survey, which was conducted by the Observatoire Régional de la Santé de Guyane. Demographic and immunization data from eligible children and their families were collected using a questionnaire. Children who had an immunization card and who were no older than 7 years of age at the time of the survey were eligible. The Coverage for BCG and other mandatory vaccines were estimated; the delay in BCG vaccination was also computed. Univariate and multivariate analyses identified predictors associated with BCG immunization and BCG delayed immunization (after 2 months of age). RESULTS AND CONCLUSION Overall, 469 children were eligible for this study. The total BCG coverage was 79.5 %, and the proportion of children vaccinated with delay was 50.7 %. The multivariate analysis indicated that BCVA was significantly greater among children younger than 3 years of age, whose household head was employed and whose education level was greater. None of the predictors were associated with the delay of BCG vaccination.
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Affiliation(s)
- Qiannan Wang
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana.
| | - Mathieu Nacher
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Département Formation Recherche Santé, Université de Guyane, Cayenne 97300, French Guiana
| | - Alice Tosi
- Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Registre des handicaps de l'enfant et observatoire périnatal de Guyane, Cayenne 97300, French Guiana
| | - Loreinzia Clarke
- Observatoire Régional de la Santé de Guyane, Cayenne 97300, French Guiana
| | - Joseph Rwagitinywa
- Observatoire Régional de la Santé de Guyane, Cayenne 97300, French Guiana
| | - Kinan Drak Alsibai
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Centre de Ressources Biologiques Amazonie, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Service d'Anatomopathologie, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana
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Conroy O, Wurie F, Collin SM, Edmunds M, de Vries G, Lönnroth K, Abubakar I, Anderson SR, Zenner D. Barriers and enablers to implementing tuberculosis control strategies in EU and European Economic Area countries: a systematic review. THE LANCET. INFECTIOUS DISEASES 2021; 21:e272-e280. [PMID: 34450080 DOI: 10.1016/s1473-3099(21)00077-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
Meeting the 2035 WHO targets of reducing tuberculosis incidence by 90% from 2015 levels requires the implementation of country-specific tuberculosis control strategies. This systematic review aims to identify factors that facilitate or impede the implementation of such strategies in EU and European Economic Area (EEA) settings. Focusing on providers of care, health system constraints, and social and political factors, this Review complements available evidence on the accessibility of tuberculosis services to recipients of care. Databases were searched for EU and EEA articles published between Jan 1, 1997, and Nov 6, 2020, that presented empirical data on tuberculosis policies, strategies, guidelines, or interventions. 2061 articles were screened and 65 were included. The most common barrier to tuberculosis control strategies described the divergence of health-care practices from guidelines, often related to inadequate knowledge or perceived usefulness of the guidelines by clinicians. The most commonly identified enabler to tuberculosis control strategies was the documented positive attitudes of health-care workers towards tuberculosis programmes. Divergence between clinical practice and guidelines was described in most EU and EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of tuberculosis control strategies analysed.
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Affiliation(s)
- Olivia Conroy
- TB Unit, National Infection Service, Public Health England, London, UK.
| | - Fatima Wurie
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Simon M Collin
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Matt Edmunds
- TB Unit, National Infection Service, Public Health England, London, UK
| | | | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Sarah R Anderson
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Dominik Zenner
- TB Unit, National Infection Service, Public Health England, London, UK; Institute for Global Health, University College London, London, UK
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3
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Faust L, Schreiber Y, Bocking N. A systematic review of BCG vaccination policies among high-risk groups in low TB-burden countries: implications for vaccination strategy in Canadian indigenous communities. BMC Public Health 2019; 19:1504. [PMID: 31711446 PMCID: PMC6849173 DOI: 10.1186/s12889-019-7868-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) vaccination against tuberculosis (TB) is widespread in high-TB-burden countries, however, BCG vaccination policies in low-burden countries vary. Considering the uncertainties surrounding BCG efficacy and the lower likelihood of TB exposure in low-incidence countries, most have discontinued mass vaccination, choosing instead a targeted vaccination strategy among high-risk groups. Given the increased risk of TB infection in Canadian Indigenous communities compared to the general Canadian population, these communities are a pertinent example of high-incidence groups in an otherwise low-burden country, warranting particular consideration regarding BCG vaccination strategy. This systematic review aims to synthesise and critically appraise the literature on BCG vaccination strategies in high-risk groups in low-incidence settings to provide policy considerations relevant to the Canadian Indigenous context. METHODS A literature search of the Medline and Embase databases was conducted, returning studies pertaining to BCG vaccine efficacy, TB incidence under specific vaccination policies, BCG-associated adverse events, and vaccination policy guidelines in low-burden countries. Study screening was tracked using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia), and data pertaining to the above points of interest were extracted. RESULTS The final review included 49 studies, spanning 15 countries. Although almost all of these countries had implemented a form of mass or routine vaccination previously, 11 have since moved to targeted vaccination of selected risk groups, in most cases due to the low risk of infection among the general population and thus the high number of vaccinations needed to prevent one case in the context of low-incidence settings. Regarding identifying risk groups for targeted screening, community-based (rather than individual risk-factor-based) vaccination has been found to be beneficial in high-incidence communities within low-incidence countries, suggesting this approach may be beneficial in the Canadian Indigenous setting. CONCLUSIONS Community-based vaccination of high-incidence communities may be beneficial in the Canadian Indigenous context, however, where BCG vaccination is implemented, delivery strategies and potential barriers to achieving adequate coverage in this setting should be considered. Where an existing vaccination program is discontinued, it is crucial that an effective TB surveillance system is in place, and that case-finding, screening, and diagnostic efforts are strengthened in order to ensure adequate TB control. This is particularly relevant in Canadian Indigenous and other remote or under-served communities, where barriers to surveillance, screening, and diagnosis persist.
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Affiliation(s)
- Lena Faust
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. .,McGill International TB Centre, Montreal, Canada.
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Winnipeg, Canada.,Clinical Sciences Division, Northern Ontario School of Medicine, Sioux Lookout, Canada
| | - Natalie Bocking
- Sioux Lookout First Nations Health Authority, Sioux Lookout, Canada
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4
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Martinez L, Fofana F, Raineri F, Arnould P, Benmedjahed K, Coindard G, Denis F, Duhot D, Gallais JL, Seyler D, Tugaut B, Arnould B. Scoring and psychometric validation of the 'Determinants of Intentions to Vaccinate' (DIVA ©) questionnaire. BMC FAMILY PRACTICE 2016; 17:143. [PMID: 27724865 PMCID: PMC5057471 DOI: 10.1186/s12875-016-0539-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/27/2016] [Indexed: 11/21/2022]
Abstract
Background Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the ‘Determinants of Intentions to Vaccinate’ (DIVA©) questionnaire that aims to assess PCPs’ attitudes and beliefs toward vaccination. Methods The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD. Results The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The ‘Commitment of the PCP to the vaccination approach’ score showed very good internal consistency reliability (Cronbach’s alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed. Conclusions The DIVA questionnaire is a valid and reliable measure of PCPs’ attitudes and beliefs toward vaccination. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0539-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luc Martinez
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of General Medicine, University Pierre-et-Marie-Curie, Paris, France
| | - Fatoumata Fofana
- Mapi, Patient-Centered Outcomes, 27, rue de la Villette, 69003, Lyon, France.
| | - François Raineri
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of bacteriology and virology, University of Limoges, Limoges, France
| | - Pascale Arnould
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of General Practice, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - Khadra Benmedjahed
- Mapi, Patient-Centered Outcomes, 27, rue de la Villette, 69003, Lyon, France
| | - Guillaume Coindard
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of General Practice, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - François Denis
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of bacteriology and virology, University of Limoges, Limoges, France
| | - Didier Duhot
- French Society of General Medicine, Issy-les-Moulineaux, France.,Department of General Medicine, SMBH University of Paris 13, Bobigny, France
| | | | - Didier Seyler
- French Society of General Medicine, Issy-les-Moulineaux, France.,Specialist in general medicine, International vaccination centre (2007-2015), Marseille, France
| | - Béatrice Tugaut
- Mapi, Patient-Centered Outcomes, 27, rue de la Villette, 69003, Lyon, France
| | - Benoit Arnould
- Mapi, Patient-Centered Outcomes, 27, rue de la Villette, 69003, Lyon, France
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Guthmann JP, Ragot M, Ben Boutieb M, Bois C, Dufourg MN, Lévy-Bruhl D. [Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011]. Rev Epidemiol Sante Publique 2016; 64:271-80. [PMID: 27553256 DOI: 10.1016/j.respe.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/25/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination. METHODS The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR). RESULTS CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80). CONCLUSION In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.
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Affiliation(s)
- J-P Guthmann
- Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France.
| | - M Ragot
- Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France
| | - M Ben Boutieb
- Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France
| | - C Bois
- Unité mixte Elfe Ined-Inserm-EFS, 94800 Villejuif, France; Service départemental de protection maternelle et infantile des Hauts-de-Seine, 92000 Nanterre, France
| | - M-N Dufourg
- Unité mixte Elfe Ined-Inserm-EFS, 94800 Villejuif, France
| | - D Lévy-Bruhl
- Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France
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Usher C, Adams R, Schmitz S, Kieran J, O'Flanagan D, O'Donnell J, Connolly K, Corcoran B, Butler K, Barry M, Walsh C. Evaluating the neonatal BCG vaccination programme in Ireland. ACTA ACUST UNITED AC 2016; 74:28. [PMID: 27413531 PMCID: PMC4942954 DOI: 10.1186/s13690-016-0141-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
Background The aim of this study was to compare the cost effectiveness of the current Irish programme of universal BCG vaccination of infants versus a programme which considered selectively vaccinating high risk infants using decision analytical modelling. Methods The efficacy of the BCG vaccine was re-evaluated to inform a decision analytical model constructed to follow a birth cohort of vaccinated and unvaccinated infants over a 15 year time horizon. The number of life years gained (LYG) was the primary outcome measure and this was compared to the net cost of the vaccination strategies. Results In the base case analysis, the incremental cost effectiveness ratios (ICERs) for the universal strategy and selective strategy vs no vaccination were €204,373/LYG and €143,233/LYG respectively. When comparing the incremental difference in moving from the universal to the selective strategy, the selective strategy costs €1,055,692 less per 4.8 life years lost per birth cohort. One way sensitivity analyses highlighted that a move from the universal to the selective strategy was particularly sensitive to the estimate of vaccine efficacy against deaths, the cost of administering the vaccine and the multiplier used to apportion risk of contracting tuberculosis. Probabilistic analysis suggested that a move from a universal based strategy to a selective based strategy could be deemed cost effective (probability of cost effectiveness is 76.8 %). Conclusion The results of the study support the protective effect of the BCG vaccine in infants and quantified the cost effectiveness of the current BCG vaccination strategy and the decremental difference in moving to a selective strategy. This analysis highlights that the additional protection offered by the universal vaccination strategy is small compared to that of the selective strategy. Consideration should therefore be given to the implementation of a selective vaccination strategy, and diverting resources to improve TB case management and control. Electronic supplementary material The online version of this article (doi:10.1186/s13690-016-0141-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cara Usher
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
| | - Roisin Adams
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
| | - Susanne Schmitz
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Jennifer Kieran
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Darina O'Flanagan
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Joan O'Donnell
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Kevin Connolly
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Brenda Corcoran
- National Immunisation Advisory Committee, Dublin 2, Ireland ; National Immunisation Office, Dublin 7, Ireland
| | - Karina Butler
- National Immunisation Advisory Committee, Dublin 2, Ireland ; Department of Infectious Diseases, Our Lady's Childrens Hospital, Crumlin, Dublin 12, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Cathal Walsh
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Maths & Statistics, Centre for Health Decision Sciences (CHeDS), University of Limerick, Limerick, Ireland
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Feiring B, Laake I, Molden T, Håberg SE, Nøkleby H, Seterelv SS, Magnus P, Trogstad L. Do selective immunisation against tuberculosis and hepatitis B reach the targeted populations? A nationwide register-based study evaluating the recommendations in the Norwegian Childhood Immunisation Programme. Vaccine 2016; 34:2015-20. [PMID: 26947498 DOI: 10.1016/j.vaccine.2016.02.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Selective immunisation is an alternative to universal vaccination if children at increased risk of disease can be identified. Within the Norwegian Childhood Immunisation Programme, BCG vaccine against tuberculosis and vaccine against hepatitis B virus (HBV) are offered only to children with parents from countries with high burden of the respective disease. We wanted to study whether this selective immunisation policy reaches the targeted groups. METHODS The study population was identified through the Norwegian Central Population Registry and consisted of all children born in Norway 2007-2010 and residing in Norway until their second birthday, in total 240,484 children. Information on vaccinations from the Norwegian Immunisation Registry, and on parental country of birth from Statistics Norway, was linked to the population registry by personal identifiers. The coverage of BCG and HBV vaccine was compared with the coverage of vaccines in the universal programme. RESULTS Among the study population, 16.1% and 15.9% belonged to the target groups for BCG and HBV vaccine, respectively. Among children in the BCG target group the BCG vaccine coverage was lower than the coverage of pertussis and measles vaccine (83.6% vs. 98.6% and 92.3%, respectively). Likewise, the HBV vaccine coverage was lower than the coverage of pertussis and measles vaccine in the HBV target group (90.0% vs. 98.6% and 92.3%, respectively). The coverage of the targeted vaccines was highest among children with parents from South Asia and Sub-Saharan Africa. The coverage of vaccines in the universal programme was similar in targeted and non-targeted groups. CONCLUSIONS Children targeted by selective vaccination had lower coverage of the target vaccines than of vaccines in the universal programme, indicating that selective vaccination is challenging. Improved routines for identifying eligible children and delivering the target vaccines are needed. Universal vaccination of all children with these vaccines could be considered.
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Affiliation(s)
- Berit Feiring
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | - Ida Laake
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | - Tor Molden
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | - Siri E Håberg
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | - Hanne Nøkleby
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | | | - Per Magnus
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
| | - Lill Trogstad
- Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
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Van Bui T, Lévy-Bruhl D, Che D, Antoine D, Jarlier V, Robert J. Impact of the BCG vaccination policy on tuberculous meningitis in children under 6 years in metropolitan France between 2000 and 2011. ACTA ACUST UNITED AC 2015; 20. [PMID: 25811645 DOI: 10.2807/1560-7917.es2015.20.11.21064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In France, Bacillus Calmette–Guérin (BCG) vaccination by multipuncture device was withdrawn in 2006. In 2007, universal mandatory BCG vaccination was replaced by vaccination of high-risk children. To evaluate the impact of these changes on tuberculous meningitis (TBM) epidemiology, data on culture-positive and culture-negative (or unknown microbiological result) TBM in ≤5 years olds were collected from 2000–2011. Ten culture-positive and 17 culture-negative TBM cases were identified, with an annual incidence rate ranging from 0.16 to 0.66 cases per 10 million inhabitants. The average annual numbers of TBM cases were 2.7 and 1.8 from 2000–2005 and 2006–2011, respectively. In Ile-de-France where all children are considered at risk, the overall incidence rates were 1.14 and 0.29 per million for the two periods. In other regions where only at-risk children are vaccinated since 2007, rates were 0.30 and 0.47, respectively. None of these differences were significant. Annual incidence rates for each one year age group cohort were comparable before and after changes. Childhood TBM remains rare in France. No increase in incidence was observed after changes in BCG vaccination strategy. Ongoing surveillance should be maintained, as a slight increase in TBM in the coming years remains possible, in the context of suboptimal vaccination coverage of high-risk children.
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Affiliation(s)
- T Van Bui
- Sorbonne Universites, UPMC Univ Paris 06, CR7, Centre d Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), Paris, France
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9
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Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine 2014; 32:2150-9. [PMID: 24598724 DOI: 10.1016/j.vaccine.2014.01.081] [Citation(s) in RCA: 1158] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/18/2014] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
Abstract
Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines.
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Affiliation(s)
- Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Elisabeth Eckersberger
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - David M D Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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10
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Vernaz A, Gaudart J, Sallah K, Casanova L, Debroise A, Laporte R, Minodier P. [BCG vaccination: survey among children less than 5 years of age in an emergency department]. Arch Pediatr 2014; 21:454-60. [PMID: 24721417 DOI: 10.1016/j.arcped.2014.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 12/09/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED France is a country with a low incidence of tuberculosis. However, there are important local variations: some parts of the city of Marseilles (southern France) presented a yearly incidence greater than 30/100,000 in 2010. The main goal of this study was to evaluate the BCG vaccine coverage among at-risk children younger than 5 years consulting in one of the city's pediatric emergency departments. MATERIAL AND METHODS This descriptive study took place in February 2013 and used a semi-directive questionnaire distributed to parents. RESULTS One hundred and thirty-five children were included, 98 (72.6 %) were considered as being at risk of tuberculosis and among them 75 (76.5 %, 95 % CI [68.0-85.1]) were vaccinated with BCG. Parents' knowledge of tuberculosis was relevant in 48 % of the respondents. Only 19 % of the parents reported that BCG protects against tuberculosis, but 73 % were in favor of this vaccination. Two criteria significantly increased vaccine coverage among at-risk children: birth in Marseilles and age more than 6 months on the consultation day. The child living in a poor family and type of medical follow-up did not significantly influence BCG vaccine coverage. CONCLUSION BCG coverage was high in at-risk children younger than 5 years born in Marseilles. Cooperation between private physicians, maternity hospitals and mothers, and children's public health services probably facilitates this high level of protection.
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Affiliation(s)
- A Vernaz
- Service d'urgences pédiatriques, CHU Nord, chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - J Gaudart
- Aix-Marseille université, UMR912 (Inserm/IRD/AMU), 13005 Marseille, France
| | - K Sallah
- Aix-Marseille université, UMR912 (Inserm/IRD/AMU), 13005 Marseille, France
| | - L Casanova
- Département de médecine générale, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France; ORS PACA, observatoire régional de santé, 13009 Marseille, France
| | - A Debroise
- Service d'urgences pédiatriques, CHU Nord, chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - R Laporte
- Service d'urgences pédiatriques, CHU Nord, chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - P Minodier
- Service d'urgences pédiatriques, CHU Nord, chemin des Bourrelly, 13920 Marseille cedex 15, France.
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Guthmann JP, Chauvin P, Le Strat Y, Soler M, Fonteneau L, Lévy-Bruhl D. Family history of immigration from a tuberculosis endemic country and low family income are associated with a higher BCG vaccination coverage in Ile-de-France region, France. Vaccine 2013; 31:5666-71. [PMID: 24120671 DOI: 10.1016/j.vaccine.2013.09.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
After withdrawal of multipuncture BCG device from the French market in January 2006, vaccination coverage (VC) with the intradermal device has dropped and since remained sub-optimal in Ile-de-France, the only region of mainland France where BCG is recommended to all children. We conducted a cross-sectional study to identify socio-economic factors associated with BCG VC in children of Paris metropolitan area born after January 2006. Two-stage random sampling was used to include 425 children up to 5 years old from Paris and its suburbs. Information was collected through face-to-face interviews and vaccination status confirmed by a vaccination document. Poisson regression analyzed the association between VC and potential determinants. VC of children from families with the lowest incomes (first quartile of family income/consumption unit (CU) (<883 €) was close to 100% regardless of family origin. In families with higher incomes (≥ 883 €/CU), VC was significantly higher among children born to families from a tuberculosis highly endemic country (98.2%) compared with other children (76.2%) (p=0.004). Children of low socio-economic background as well as those with a family history of immigration, regardless of family income, are correctly identified as being at high risk of tuberculosis and properly vaccinated with BCG in this area.
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Affiliation(s)
- Jean-Paul Guthmann
- Institut de veille sanitaire, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France.
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Lungarde K, Blaizeau F, Auger-Aubin I, Floret D, Gilberg S, Jestin C, Hanslik T, Le Goaster C, Lévy-Bruhl D, Blanchon T, Rossignol L. How French physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups. BMC FAMILY PRACTICE 2013; 14:85. [PMID: 23782853 PMCID: PMC3691920 DOI: 10.1186/1471-2296-14-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 06/14/2013] [Indexed: 11/18/2022]
Abstract
Background As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians’ agreement about this modification. Methods Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. Results The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient’s vaccination status. Conclusions Physicians’ opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians’ suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule.
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Blaizeau F, Lasserre A, Rossignol L, Blanchon T, Kernéis S, Hanslik T, Levy-Bruhl D. Practices of French family physicians concerning varicella vaccination for teenagers. Med Mal Infect 2012; 42:429-34. [PMID: 22939236 DOI: 10.1016/j.medmal.2012.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/18/2012] [Accepted: 07/24/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors assessed the knowledge and practices of French family physicians concerning the application of the new 2007 varicella vaccination guidelines for non-immune teenagers, 12 to 18 years of age. They also estimated the vaccination coverage in this population. METHOD A questionnaire link was sent by to 1008 family physicians of the French Inserm Sentinel network. Each family physician had to include the last teenager aged 12 to 18 years seen in consultation, with no or uncertain history of clinical varicella. RESULTS One hundred and forty-one family physicians agreed to participate and included one patient (participation rate=14%) between 4th November 2010 and 4th January 2011. One hundred and thirty-three questionnaires out of 141 (94%) were analyzed. Three patients were vaccinated and 127 were not, giving a weak vaccination coverage in the investigated population at 2%. Eighty-nine family physicians (70%) did not know about the recommendation, and 90 (71%) declared that they had no intention to vaccinate their patient against varicella. CONCLUSION Guidelines on varicella vaccination of non-immune teenagers are poorly followed and accepted by family physicians. Vaccination coverage is very low, and efforts should be made to improve application of recommendations.
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Affiliation(s)
- F Blaizeau
- Inserm U707, 27, rue de Chaligny, 75571 Paris cedex 12, France.
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