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Attitudes towards monkeypox vaccination among healthcare workers in France and Belgium: an element of complacency? J Hosp Infect 2022; 130:144-145. [PMID: 36174773 PMCID: PMC9534062 DOI: 10.1016/j.jhin.2022.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022]
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Stratégies innovantes de vaccination anti-pneumococcique par rapport au schéma standard chez les patients atteints de vascularites associées aux ANCA recevant du rituximab : essai contrôlé randomisé multicentrique (PNEUMOVAS). Rev Med Interne 2022. [PMCID: PMC9724759 DOI: 10.1016/j.revmed.2022.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Les patients recevant des glucocorticoïdes et du rituximab (RTX) présentent un risque accru d’infections, en particulier d’infections invasives à pneumocoque. Les réponses vaccinales au virus de la grippe, au Streptococcus pneumoniae et au SARS-CoV-2 sous traitement par RTX sont fortement altérées. Chez les patients atteints de maladies auto-immunes recevant de tels traitements, en particulier ceux atteints de vascularites associées aux ANCA (AAV), il est donc nécessaire de développer des stratégies vaccinales anti-pneumococciques améliorées pour augmenter la réponse immunitaire et la protection vaccinale. Patients et méthodes Cet essai multicentrique de phase 2, randomisé, ouvert, a comparé deux stratégies innovantes de vaccin anti-pneumococcique « renforcées » au schéma de vaccination standard chez des patients atteints de VAA recevant un traitement par RTX. Des patients adultes atteints de VAA nouvellement diagnostiquée ou en rechute, présentant une maladie active (BVAS ≥ 3) et devant recevoir du RTX comme traitement d’induction (375 mg/m2/semaine pendant 4 semaines consécutives), ont été randomisés avec un rapport 1:1:1 dans trois bras parallèles : schéma standard associant une dose de vaccin pneumococcique conjugué 13-valent (PCV13) au jour 0 suivie d’une dose de vaccin non conjugué 23-valent (PPV23) au mois 5 (M5) (bras 1) ; double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose de PPV23 à M5 (bras 2) ; ou 4 doses de PCV13 au jour 0 suivies d’une dose de PPV23 à M5 (bras 3). Le critère d’évaluation principal était la réponse immunitaire à M6 contre les 12 sérotypes de pneumocoque communs aux vaccins PCV13 et PPV23, classée selon quatre catégories ordonnées de réponse : réponse positive en anticorps contre 0–3, 4–6, 7–9 ou 10–12 sérotypes. Une réponse positive par sérotype était définie par un titre ELISA d’IgG spécifiques ≥ 1 μg/mL et une augmentation de deux fois par rapport au jour 0. Le critère d’évaluation primaire a été analysé dans un modèle de régression logistique à chances proportionnelles avec une correction de Bonferonni pour les 2 bras innovants. Les critères d’évaluation secondaires étaient les réactions locales et systémiques sollicitées 7 jours après chaque vaccination et tout événement indésirable lié ou pouvant être lié à l’immunisation vaccinale. Résultats Quatre-vingt-quinze participants ont été analysés dans la population modifiée en intention de traiter (âge moyen 60 ± 16,6 ans, 50 % d’hommes, 74 personnes atteintes d’une maladie nouvellement diagnostiquée, 66 d’une granulomatose avec polyangéite et 29 d’une polyangéite microscopique, BVAS moyen 15,3 ± 6,9), dont 30 affectés au bras 1, 32 au bras 2 et 33 au bras 3. À M6, une réponse immunitaire contre 0–3, 4–6, 7–9 ou 10–12 sérotypes était observée chez 83,3 %, 13,3 %, 3,3 % et 0 % dans le bras 1 ; 56,3 %, 28,1 %, 15,6 % et 0 % dans le bras 2 ; et 60,6 %, 33,3 %, 6,1 % et 0 % dans le bras 3. Les patients du bras 2 étaient significativement plus susceptibles de se trouver dans une catégorie de réponse supérieures par rapport au régime standard après ajustement sur l’âge, avec un odds ratio proportionnel (pOR) de 4,1 (IC97,5 % : 1,1–15,9, p = 0,018), tandis que le bras 3 montrait une tendance non significative à améliorer les réponses vaccinales (pOR : 3,1, IC97,5 % : 0,8–11,9, p = 0,062). Une analyse de sensibilité sur une population per-protocole excluant les patients ayant subi des vaccinations ou des prises de sang hors des délais donnait des estimations concordantes. Les réactions locales et/ou systémiques dans les 7 jours après chaque vaccination, et tout événement indésirable lié ou possiblement lié à la vaccination au cours des 6 premiers mois, sont survenus en plus grand nombre avec les schémas renforcés mais étaient principalement des réactions locales de grade 1 ou 2. Aucun événement indésirable grave lié à la vaccination n’a été observé. Au cours du suivi, 8 poussées de vascularite sont survenues chez 6 patients, en médiane 87 jours après la dernière vaccination : un patient dans le bras 1, 2 dans le bras 2, et 3 dans le bras 3. Conclusion Chez les patients atteints de VAA recevant un traitement par RTX, une stratégie innovante de vaccination anti-pneumococcique renforcée, basée sur une double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose unique de PPV23 à M5, améliore significativement les réponses en anticorps contre Streptococcus pneumoniae par rapport au schéma standard.
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Heterologous prime boost COVID 19 vaccination. Infect Dis Now 2022; 52:S7-S8. [PMID: 36108969 PMCID: PMC9468048 DOI: 10.1016/j.idnow.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Immunité humorale à la vaccination Covid-19 en populations particulières : résultats préliminaires de la cohorte ANRS0001 S COV-POPART. MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152496 DOI: 10.1016/j.mmifmc.2022.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction L'efficacité de la vaccination Covid-19 est diminuée chez les personnes immunodéprimées. La réponse en anticorps anti-Spike est hétérogène dans ces populations mais la plupart des études publiées sont de taille limitée sans groupe contrôle. Matériels et méthodes COV-POPART est une cohorte nationale prospective multicentrique ayant inclus, entre le 25 mars et le 31 décembre 2021, des participants adultes dans 11 populations particulières (cancer solide, transplantés organe solide (TOS), greffés cellules souches hématopoïétiques (GCSH), insuffisants rénaux chroniques (IRC), maladies auto-immunes et systémiques (MAIS), rhumatismes inflammatoires chroniques (RIC), Sclérose En Plaques et maladies du spectre de la neuromyélite optique (SEP), hypogammaglobulinémie, diabète (1 et 2), obésité sans diabète, Personnes Vivant avec le VIH-1 (PVVIH)) et 2 groupes contrôles (18-74 ans et > 74 ans) indemnes des affections suscitées. Les participants ayant à l'inclusion des anticorps anti-nucléocapside (NCP) positifs ont été exclus. La proportion de participants avec des anticorps IgG anti-Spike (ELISA Euroimmun) (=répondeurs) et des anticorps neutralisants spécifiques (test de neutralisation in vitro sur la souche originale) a été évaluée de manière standardisée et centralisée un mois après la deuxième dose de vaccin. Résultats Parmi les 6612 participants de la cohorte, 3301 avaient des résultats disponibles au 17/02/2022 et 3127 des anticorps anti-NCP négatifs : 2271 participants de populations particulières (156 cancers solides, 135 TOS, 47 GCSH, 81 IRC, 124 MAI, 129 RIC, 321 SEP, 50 hypogammaglobulinémies, 320 diabétiques, 623 obèses non diabétiques et 777 VIH) et 856 contrôles (831 : 18-74 ans et 25 : >74 ans). La majorité des participants (86,7%) a reçu deux doses de BNT162b2. Dans le groupe contrôle, 99,9% (IC95% 99,3 ; 100,0) des personnes âgées de 18 à 74 ans et 96,0% (79.6 ; 99,9) des personnes âgées de plus de 75 ans ont développé des anticorps IgG anti-Spike. Chez les patients obèses et les PVVIH, les pourcentages de répondeurs étaient de 88,9 % (86,2 ; 91,3) et 97.3 % (95,9 ; 98,3). Les pourcentages de répondeurs étaient plus faibles chez les SEP (73,8 % [68,7 ; 78,6]), GCSH (61,7 % [46,4 ; 75,5]) ou TOS (31,1 % [23,4 ; 39,6]). La fréquence des anticorps neutralisants était similaire à celle des anticorps anti-Spike dans les groupes contrôles. Les obèses et PVVIH (85,8 % [82,8 ; 88,5] et 95,6 % [93,9 ; 96,9]) présentaient plus fréquemment des anticorps neutralisants contrairement aux participants SEP, GSCH et TOS (69,8 % [64,4 ; 74,8], 57,4 % [42,2 ; 71,7] et 27,4 % [20,1 ; 35,7]). Conclusion Les résultats préliminaires de la cohorte COV-POPART montrent, à 1 mois de la fin du schéma vaccinal standard de primo-vaccination Covid-19, une réponse humorale hétérogène dans les populations particulières. Cette réponse est plus faible chez les patients atteints de SEP, GSCH ou TOS. Aucun lien d'intérêt
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Perception et connaissances des patients à haut risque d'infection sur la vaccination contre la grippe et le pneumocoque pendant la pandémie COVID-19. MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152562 DOI: 10.1016/j.mmifmc.2022.03.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction L'objectif de notre étude était d'évaluer, dans une population à risque, la perception et la connaissance des vaccinations contre la grippe et les pneumocoques pendant la pandémie de Covid-19. Matériels et méthodes Une enquête anonyme en ligne a été soumise, entre juillet et octobre 2020, à des patients porteurs de pathologies chroniques et/ou immunodéprimés issus soit d'un panel interne à Ipsos soit d'associations de patients du groupement AVNIR (Associations VacciNation Immunodéprimées Réalité). Résultats Au total, 2 177 questionnaires de patients à risque d'infection ont été analysés. La quasi-totalité des répondants (86 %, 1869/2177) a déclaré être favorable à la vaccination. Près de la moitié des patients (49 %, 1069/2177) savait quels vaccins étaient recommandés du fait de leur pathologie ou traitements spécifiques. Ce pourcentage était significativement (p<0,001) plus élevé pour les membres d'une association de patients et pour les personnes affectées par plusieurs pathologies chroniques et variait selon le type de pathologie. Près de deux tiers des patients (1373/2177), ont déclaré avoir été vaccinés pendant la saison grippale 2019/2020 et 41 % (894/2177) étaient certains d'être à jour de la vaccination contre le pneumocoque. Les principaux freins à la vaccination étaient pour la grippe : la crainte des effets secondaires et le doute sur l'efficacité du vaccin et pour la vaccination anti-pneumococcique : l'absence de proposition de vaccination de la part des professionnels de santé (64 %). Les médecins généralistes étaient reconnus comme les principaux professionnels de santé source d'information sur la vaccination. Près de deux tiers des patients (62 %, 1360/2177) ont déclaré que la pandémie de COVID-19 les avait convaincus de faire tous les vaccins recommandés. Conclusion Cette étude a mis en évidence des couvertures vaccinales contre la grippe et le pneumocoque non optimales dans les populations à risque malgré une perception positive de la vaccination. Elle a confirmé que les médecins sont en première ligne pour suggérer et recommander ces vaccinations surtout dans le contexte actuel de la pandémie Covid-19 qui peut être utilisé pour promouvoir d'autres vaccins. Liens d'intérêts déclarés P.L : Interventions ponctuelles : activité de conseil et d'expertise pour Pfizer
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Un volontaire aux essais vaccinaux COVID-19 serait-il prêt à participer à un essai clinique vaccinal non COVID-19 ? MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152481 DOI: 10.1016/j.mmifmc.2022.03.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Matériels et méthodes Résultats Conclusion
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Caractéristiques des volontaires inscrits sur la plateforme nationale dédiée aux essais vaccinaux COVID-19. Infect Dis Now 2021. [PMCID: PMC8327591 DOI: 10.1016/j.idnow.2021.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction La conduite des essais vaccinaux COVID-19 nécessite le recrutement d’un nombre important de participants dans un délai court. Dans ce contexte, une plateforme nationale informatisée permettant l’auto-inscription de volontaires a été mise en place. Ce concept inédit en France permet de cibler les populations correspondant aux critères d’inclusion, d’assurer une répartition géographique et de garantir aux promoteurs, industriels ou académiques, le recrutement rapide dans les essais. L’objectif du travail présenté ici est de décrire les caractéristiques des volontaires inscrits. Matériels et méthodes Un appel à volontaires a été lancé le 01/10/2020 sous la forme d’une conférence de presse. Il a aussi été relayé par les médecins généralistes. Tout adulte pouvait s’inscrire sur une plateforme déclarée à la CNIL accessible à partir d’un site internet contenant des informations sur le développement des vaccins COVID-19. Le volontaire devait renseigner son identité et ses coordonnées, donner expressément son consentement puis des informations concernant : – son poids, sa taille et l’existence d’une ou plusieurs comorbidités (diabète, hypertension artérielle, maladie cardiaque et/ou respiratoire, insuffisance rénale, transplantation d’organe solide, maladie auto-immune et cancer) ; – la prise d’un traitement au long cours, notamment d’un immunosuppresseur ; – son exposition à la COVID-19 (professionnel de santé, métier au contact du public) ou un antécédent de COVID-19 ; – sa participation antérieure à un essai clinique. Les données des volontaires inscrits entre le 01/10/2020 et le 21/12/2020 ayant donné leur consentement et dont les données d’identité étaient complètes ont fait l’objet de cette analyse, effectuée avec le logiciel STATA®. Résultats Au total, 45503 inscriptions ont été enregistrées, dont 44611 (98%) analysées ici. Il s’agit d’hommes dans 63% des cas (n = 28049, sexratio : 1,7); l’âge médian est de 51 ans (IQR : 35-63 ans). Les personnes âgées de 65 ans et plus représentent 22% (n = 9551) des volontaires; 1,2% (n = 507) ont 80 ans et plus. Au moins une comorbidité est présente chez 14609 (39%) volontaires: 16% d’obésité (n = 6054), 16,5 % d’hypertension artérielle (n = 6243), 6% de diabète (n = 2251), 6,6% de maladie cardiaque (n = 2493), 9,9% de maladie respiratoire (n = 3747), 0,4 % d’insuffisance rénale (n = 160), 5,2 % de maladie auto-immune (n = 1976), 0,8% de cancer (n = 306) et 0,3% de transplantés (n = 117). Cinq pour cent (n = 2284) ont déclaré un antécédent de COVID-19 et 13% (n = 5654) sont des professionnels de santé. Conclusion La mise en place d’une plateforme nationale dédiée aux essais vaccinaux COVID-19 est une première en France et a permis l’inscription d’un grand nombre de participants potentiels grâce à un fort relais par la presse nationale et un accueil positif des français de tous les âges. Cet outil doit garantir un recrutement rapide dans les essais vaccinaux COVID-19 en cours et pourrait constituer de façon plus générale une approche efficace pour dynamiser le recrutement des essais cliniques en France.
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Is COVID-19 pneumonia differentiable from other viral pneumonia on CT scan? Respir Med Res 2021; 79:100824. [PMID: 33971431 PMCID: PMC8078041 DOI: 10.1016/j.resmer.2021.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
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Evolution of practices regarding COVID-19 treatment in France during the first wave: results from three cross-sectional surveys (March to June 2020). J Antimicrob Chemother 2021; 76:1372-1374. [PMID: 33496328 PMCID: PMC7928947 DOI: 10.1093/jac/dkaa564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Online vaccine-related information-seeking in mothers and HPV vaccine uptake in their daughters. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is widespread concern about online vaccine misinformation. The aim of this study was to investigate the association between seeking vaccine-related information on the Internet and HPV vaccination uptake.
Methods
Data were obtained from the 2015, 2016, 2017 and 2018 Vaccinoscopie® studies, a pluriannual web-based survey conducted on a nationally representative quota sample of mothers to monitor the dynamics of vaccine coverage, perception and attitudes towards vaccination in France. Mothers of girls aged 14-15 years were asked to state all vaccinations reported on the vaccinal pages of their child's healthcare records. We computed univariate and multivariate logistic regression models, with the outcome variable “HPV vaccination” defined as equal to 1 if the daughter received at least one dose of HPV vaccine, and equal to 0 otherwise; and the dependant variable “Internet use” defined as equal to 1 if the mother responded “Internet” (alone or combined with other sources) to the question “When in doubt about a vaccine, what source(s) of information do you turn to to decide whether or not to have your child vaccinated?”, and equal to 0 otherwise.
Results
Over the 4 years, a total of 2038 mothers answered the self-administered online questionnaire. Overall, 96.1% declared their need to search for information, 23.9% of whom used the Internet as a source. Maternal Internet use was associated with lower HPV vaccination uptake in their daughters (Odds Ratio (OR)=0.49, 95%CI: 0.38-0.64). The association remained after adjusting for several potential confounders, including area of residence, household socio-professional category and income, maternal level of education, physician recommendation and use of other sources of information (adjusted OR = 0.68, 95%CI: 0.48-0.96).
Conclusions
Specific information campaigns are required to empower parents to better use online information and guide them to reputable sources when they seek information on vaccination.
Key messages
The findings of this study suggest that the use of online sources on information is negatively associated with HPV vaccination. Action is warranted to direct parents to use more correct online sources of information on vaccination.
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Estimation du fardeau hospitalier direct et attribuable à la grippe en France à partir de la base PMSI. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Characteristics of human metapneumovirus infection in adults hospitalized for community-acquired influenza-like illness in France, 2012-2018: a retrospective observational study. Clin Microbiol Infect 2020; 27:127.e1-127.e6. [PMID: 32283266 PMCID: PMC7195031 DOI: 10.1016/j.cmi.2020.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/27/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022]
Abstract
Objectives To describe the prevalence, clinical features and complications of human metapneumovirus (hMPV) infections in a population of adults hospitalized with influenza-like illness (ILI). Methods This was a retrospective, observational, multicenter cohort study using prospectively collected data from adult patients hospitalized during influenza virus circulation, for at least 24 h, for community-acquired ILI (with symptom onset <7 days). Data were collected from five French teaching hospitals over six consecutive winters (2012–2018). Respiratory viruses were identified by multiplex reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal specimens. hMPV + patients were compared with hMPV– patients, influenza+ and respiratory syncytial virus (RSV)+ patients using multivariate logistic regressions. Primary outcome was the prevalence of hMPV in patients hospitalized for ILI. Results Among the 3148 patients included (1449 (46%) women, 1988 (63%) aged 65 and over; 2508 (80%) with chronic disease), at least one respiratory virus was detected in 1604 (51%, 95% confidence interval (CI) 49–53), including 100 cases of hMPV (100/3148, 3% 95% CI 3–4), of which 10 (10%) were viral co-infection. In the hMPV + patients, mean length of stay was 7 days, 62% (56/90) developed a complication, 21% (14/68) were admitted to intensive care unit and 4% (4/90) died during hospitalization. In comparison with influenza + patients, hMPV + patients were more frequently >65 years old (adjusted odds ratio (aOR) = 3.3, 95% CI 1.9–6.3) and presented more acute heart failure during hospitalization (aOR = 1.8, 95% CI 1.0–2.9). Compared with RSV + patients, hMPV + patients had less cancer (aOR = 0.4, 95% CI 0.2–0.9) and were less likely to smoke (aOR = 0.5, 95% CI 0.2–0.9) but had similar outcomes, especially high rates of respiratory and cardiovascular complications. Conclusions Adult hMPV infections mainly affect the elderly and patients with chronic conditions and are responsible for frequent cardiac and pulmonary complications similar to those of RSV infections. At-risk populations would benefit from the development of antivirals and vaccines targeting hMPV.
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Barriers and motivations for participation in preventive vaccine clinical trials: Experience of 5 clinical research sites. Vaccine 2019; 37:6633-6639. [PMID: 31543417 DOI: 10.1016/j.vaccine.2019.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
Recruitment in preventive vaccine trials (PVT) is challenging due to common barriers to clinical research and lack of vaccine confidence. Identifying determinants of participation can help to improve recruitment. A prospective survey was conducted in 5 French clinical investigational sites. People asked to participate in a PVT were given a questionnaire whether they decided to participate or not in the trial. A total of 341 people answered the survey: 210 accepting and 131 declining to participate in a PVT. Acceptors were significantly younger (38.5 vs 54.9 years old), more likely to be involved in early phase trials, had a higher level of education (p < 0.005) and a significantly better general opinion concerning vaccines (92.3% versus 72.3%, p < 0.005) compared with those who declined. Factors associated with acceptance or refusal were evaluated in 224 people in the 4 sites where both groups were included. In a multivariate analysis, three factors: older age, having heard about PVT through multiple sources and financial incentives were significantly associated with refusal to participate in the PVT. A generally favourable opinion of vaccines was associated with acceptance. The main motivation for participation was altruism (93.2%) whereas fear of side effects was at the forefront of the barriers (36.6%). Information given by the physician was a key point for decision-making in 70.2% of those who accepted. In brief, vaccine hesitancy may decrease recruitment in PVTs; reinforcing altruism and quality of information given are key points in acceptance of participation in PVT.
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Safety and efficacy of inactivated varicella zoster virus vaccine in immunocompromised patients with malignancies: a two-arm, randomised, double-blind, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:1001-1012. [DOI: 10.1016/s1473-3099(19)30310-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
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Bacillus Calmette-Guerin infection following intravesical instillation: Does the strain matter? Med Mal Infect 2018; 49:350-355. [PMID: 30583869 DOI: 10.1016/j.medmal.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/02/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains. METHODS A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used. RESULTS Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P=0.003) and ICU admission (7.1% vs. 62.5%, P=0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P=0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P=0.001) were observed in these patients. No difference in terms of recovery was reported. CONCLUSION The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections.
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Abstract
INTRODUCTION Vaccination constitutes a major advance in the prevention of infectious diseases. The principle of vaccination is to induce protection against a pathogen by mimicking its natural interaction with the human immune system. The vaccine reduces the risk of complications and mortality following subsequent exposure to an infectious agent. STATE OF THE ART In this review we recall the history of vaccination as well as the basic immunological principles underlying the composition of vaccines and the response to vaccination. In this way, vaccines induce the immune system to produce an immunological memory based on T and B lymphocytes in order to produce a rapid and effective response to exposure to the targeted pathogen. OUTLOOK The improvement of existing vaccines and the discovery of new vaccines requires an understanding of the immunological principles of vaccination. Great challenges remain, particularly in terms of target pathogens for future vaccine candidates and also the acceptance of vaccination. CONCLUSION Understanding the principles of vaccination allows development of vaccines and the control of infectious diseases.
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[How to minimize the risk of infection in systemic lupus erythematosus?]. Rev Med Interne 2018; 40:347-350. [PMID: 29937299 DOI: 10.1016/j.revmed.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
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La vaccination anti-pneumococcique est insuffisamment réalisée chez les patients à risque : à propos de 693 cas d’infections invasives à pneumocoque. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Efficacité de la vaccination antigrippale saisonnière 2017–2018 chez l’adulte hospitalisé. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Étude rétrospective des infections à virus respiratoire syncytial (VRS) chez l’adulte hospitalisé en Europe. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France. Vaccine 2018; 36:1285-1296. [PMID: 29397227 DOI: 10.1016/j.vaccine.2018.01.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/15/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND CMV infections are the most frequent congenital infections worldwide. AIM Assess the cost-effectiveness of vaccination strategies of adolescent girls vs. current practice (hygiene counseling) to prevent CMV seroconversions during pregnancy in France. METHOD A Markov decision-tree model simulated overtime the trajectory of a single fictive cohort of 390,000 adolescent women aged 14 years old, living in France. Impact of vaccination was explored until the end of their reproductive live 40 years later. STRATEGIES COMPARED: "S1: No vaccination" (current practice); "S2: Routine vaccination"; "S3: Screening and vaccination of the seronegative". MODEL PARAMETERS Seroconversion rate without vaccination (0.035%/pregnant woman-week); fetal transmission risk (41%). Vaccine vs. no vaccination: a 50% decrease in maternal seroconversions. OUTCOMES Quality-Adjusted Life-Years (QALYs) of the cohort-born babies; discounted costs; Incremental Cost-Effectiveness Ratio (ICER). RESULTS S2 was the most effective strategy (with 35,000 QALYs gained) and the most expensive (€211,533,000); S1 was the least effective and least costly (€75,423,000). ICERs of strategy S3 vs. S1, and S2 vs. S3 were 6,000€/QALY gained (95% uncertainty range [2700-13,300]) and 16,000€/QALY [negative ICER (S3 dominated by S2) - 94,000] gained, respectively; highly cost-effective because ICER < 1∗France's GPD/capita = €30,000. SENSITIVITY ANALYSIS If the seroprevalence was >62% (vs. 20% in the base case), S3 would become the most efficient strategy. CONCLUSION In France, systematic vaccination of adolescent girls was the most efficient strategy to prevent maternal seroconversions. If the population was less than 62% immune, systematic screening and vaccination of susceptibles would become the most cost-effective approach.
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Les vaccins dans la prévention des infections associées aux soins. JOURNAL DES ANTI-INFECTIEUX 2017. [PMCID: PMC7148680 DOI: 10.1016/j.antinf.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Les infections associées aux soins (IAS) constituent un véritable problème de santé publique. Escherichia coli, Staphylococcus aureus, Clostridium difficile sont les plus souvent à l’origine des IAS. L’antibiorésistance fréquente complique encore la prise en charge et des impasses thérapeutiques existent à présent. Les mesures d’hygiène hospitalière bien qu’essentielles sont insuffisantes pour diminuer drastiquement les IAS. Ainsi, des stratégies alternatives à l’antibiothérapie s’avèrent nécessaires pour prévenir et traiter les IAS. Parmi celles-ci, la vaccination et l’immunisation passive sont probablement les plus prometteuses. Nous avons fait une mise au point sur les vaccins disponibles et en développement clinique pour lutter contre les IAS, chez les patients à risque d’IAS et les soignants. L’intérêt de la vaccination grippale et rotavirus chez les patients pour prévenir ces IAS virales a été examiné. Le développement d’un vaccin anti-S. aureus, déjà émaillé de 2 échecs est complexe. Toutefois, ces échecs ont permis d’améliorer les connaissances sur l’immunité anti-S. aureus. La mise à disposition d’un vaccin préventif anti-C. difficile semble plus proche. Pour les autres bactéries gram négatif responsables d’IAS, le développement est moins avancé. La vaccination des patients à risques d’IAS pose également des problèmes de réponse vaccinale qu’il faudra résoudre pour utiliser cette stratégie. Ainsi, la vaccination des soignants, de par l’effet de groupe permet également de prévenir les IAS. Nous faisons ici le point sur l’intérêt de la vaccination des soignants contre la rougeole, la coqueluche, la grippe, la varicelle, l’hépatite B pour réduire les IAS avec des vaccins déjà disponibles.
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PRODUCTION OF TNF EX VIVO IS PREDICTIVE OF AN IMMUNE RESPONSE TO FLU VACCINATION IN ELDERLY SUBJECTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Réévaluation des carbapénèmes dans la vraie vie : la conformité est-elle médecin-dépendante ? Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Facteurs associés à la couverture vaccinale contre la grippe et le pneumocoque chez des patients atteints de maladies inflammatoires chroniques de l’intestin. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Description des patients adultes hospitalisés pour une grippe au cours de l’épidémie 2016–2017 : étude prospective multicentrique FLUVAC. Med Mal Infect 2017. [PMCID: PMC7131094 DOI: 10.1016/j.medmal.2017.03.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction La surveillance épidémiologique de la grippe saisonnière 2016–2017 montre une activité forte, principalement liée à la circulation du virus A (H3N2). L’objectif de ce travail était de décrire les caractéristiques des patients adultes hospitalisés durant l’épidémie grippale. Matériels et méthodes À partir du 15 décembre 2016, tous les patients adultes hospitalisés pour un syndrome grippal évoluant depuis moins de 7 jours ont été prospectivement inclus dans le cadre de l’étude FLUVAC (Inserm) conduite dans 5 hôpitaux français dont l’objectif est d’évaluer l’efficacité de la vaccination antigrippale sur les grippes hospitalisées de l’adulte. Les caractéristiques démographiques, cliniques et virologiques ont été recueillies. Résultats Parmi, les 401 patients inclus jusqu’au 6 février, 155 (38 %) avaient une grippe documentée : dans 154 cas (99 %) il s’agissait d’un virus influenza de type A ; 9 patients avaient une co-infection avec un virus respiratoire (1 adénovirus, 1 bocavirus, 1 coronavirus, 1 métapneumovirus, 1 parainfluenzae, 2 Picornavirus, 2 virus respiratoire syncytiaux). Il y avait 83 hommes (53 %), l’âge médian était de 78 ans (intervalle interquartiles : 63–87), 34 % (53/155) avaient plus de 85 ans. Les symptômes étaient : fièvre (90 %, n = 139), malaise (20 %, n = 32), céphalées (23 %, n = 36), myalgies (25 %, n = 39), toux (89 %, n = 139), altération de l’état général (44 %, n = 68) et dyspnée (75 %, n = 117). La couverture vaccinale globale était de 51 % (79/155), 61 % (69/113) chez les plus de 65 ans, 24 % (10/41) chez les moins de 65 ans. Chez les moins de 65 ans, 68 % (28/41) avaient des comorbidités : maladie respiratoire chronique (34 %, n = 14), cardiopathie (17 %, n = 7), néphropathie chronique (12 %, n = 5), maladie neurologique (12 %, n = 5), diabète (10 %, n = 4), traitement immunosuppresseurs (29 %, n = 12), tabagisme actif (29 %, n = 12). Les complications en cours d’hospitalisation étaient principalement respiratoires dans 31 % des cas (5 SDRA, 24 recours à la ventilation mécanique), insuffisance cardiaque (13 %, n = 20) et insuffisance rénale (15 %, n = 24) dont 22 patients hospitalisés en réanimation (13 détresses respiratoires, 5 insuffisances rénales, 3 insuffisances cardiaques, 2 états de choc), d’âge médian 66 ans (59–75). Dans 86 % des cas (19/22), il existait chez ces patients une comorbidité : respiratoire (59 %, n = 13), cardiaques (36 %, n = 8), diabète (22 %, n = 4). À la date du 6 février, trois décès ont été recensés et 93 patients sont sortis à leur domicile. Conclusion L’analyse démographique des patients hospitalisés en France au cours de l’épidémie grippale 2016–2017 montre une forte activité en particulier chez les patients âgés ou présentant des comorbidités et une couverture vaccinale modérée.
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DTPID : comment sont vaccinés les patients atteints d’une maladie inflammatoire systémique ? Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[More mandatory vaccines, the first step for suppression of obligation: A public health issue]. Med Mal Infect 2017; 47:77-80. [PMID: 28258779 DOI: 10.1016/j.medmal.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/02/2017] [Indexed: 11/17/2022]
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[Adult immunisation: General points, hot topics and perspectives]. Rev Med Interne 2017; 38:749-759. [PMID: 28214181 DOI: 10.1016/j.revmed.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
Vaccination in immunocompetent adult mainly concerns booster vaccination against diphtheria, tetanus, polio and pertussis. Some chronic diseases may also require the achievement of pneumococcal and influenza vaccines. In addition, from the age of 65, annual influenza vaccination as well as one dose of a live attenuated shingles vaccine between 64 and 75 years are recommended. Immunocompromised adults, due to the increased risk of serious infections responsible of significant morbidity and mortality, are particularly concerned by vaccination. Main issues in this population are the decreased immunogenicity and efficacy of vaccination and the risk of infection with live attenuated vaccines and. Depending on the type of immunosuppression, the recommended vaccines and vaccination schemes differ. Vaccination of healthy persons caring or residing with immunocompromised patients is an important point in the vaccine strategy. The current perspectives in vaccinology concern the development of vaccines against healthcare associated infections (Clostridium difficile and Staphylococcus aureus in particular), the strategy of vaccination during pregnancy to protect new-borns (respiratory syncytial virus, group B streptococcus) and the development of new adjuvants and new routes of immunization. With the overall decline in immunization coverage and increasing distrust of vaccination, the problem of vaccine hesitancy is also a hot topic. The reasons for doubt in the vaccine usefulness and the solutions to be applied are also crucial issues.
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Uvéite syphilitique : étude rétrospective tricentrique de 67 patients. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France. Clin Microbiol Infect 2016; 23:253-259. [PMID: 27903461 PMCID: PMC7128342 DOI: 10.1016/j.cmi.2016.11.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyse characteristics and outcome of respiratory syncytial virus (RSV) infection in adults hospitalized with influenza-like illness (ILI). METHODS Patients hospitalized with ILI were included in this prospective, multicentre study carried out in six French hospitals during three consecutive influenza seasons (2012-2015). RSV and other respiratory viruses were detected by multiplex PCR in nasopharyngeal swabs. Risk factors for RSV infection were identified by backward stepwise logistic regression analysis. RESULTS A total of 1452 patients hospitalized with ILI were included, of whom 59% (861/1452) were >65 years and 83% (1211/1452) had underlying chronic illnesses. RSV was detected in 4% (59/1452), and influenza virus in 39% (566/1452). Risk factors for RSV infection were cancer (adjusted OR 2.1, 95% CI 1.1-4.1, p 0.04), and immunosuppressive treatment (adjusted OR 2.0, 95% CI 1.1-3.8, p 0.03). Patients with RSV had a median length of stay of 9 days (6-25), and 57% of them (30/53) had complications, including pneumonia (23/53, 44%) and respiratory failure (15/53, 28%). Fifteen per cent (8/53) were admitted to an intensive care unit, and the in-hospital mortality rate was 8% (4/53). Pneumonia was more likely to occur in patients with RSV than in patients with RSV-negative ILI (44% (23/53) versus 26% (362/1393), p 0.006) or with influenza virus infection (44% versus 28% (157/560), p 0.02). CONCLUSION RSV is an infrequent cause of ILI during periods of influenza virus circulation but can cause severe complications in hospitalized adults. Risk factors for RSV detection in adults hospitalized with ILI include cancer and immunosuppressive treatment. Specific immunization and antiviral therapy might benefit patients at risk.
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Échec de la vaccination antipneumococcique en phase d’attaque du traitement des vascularites à ANCA : l’étude Pneumovas Pilote 1. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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RESPIR-08 - Facteurs associés à la gravité d’une grippe confirmée chez des adultes hospitalisés en France de 2012 à 2015 : une étude prospective multicentrique. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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VAC-04 - Echec de la vaccination antipneumococcique en phase d’attaque du traitement des vascularites à ANCA : l’étude pneumovas pilote 1. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30530-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moderate influenza vaccine effectiveness against hospitalisation with A(H3N2) and A(H1N1) influenza in 2013-14: Results from the InNHOVE network. Hum Vaccin Immunother 2016; 12:1217-24. [PMID: 27065000 DOI: 10.1080/21645515.2015.1126013] [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] [Indexed: 10/22/2022] Open
Abstract
We conducted a multicentre test negative case control study to estimate the 2013-14 influenza vaccine effectiveness (IVE) against hospitalised laboratory confirmed influenza in 12 hospitals in France, Italy and Spain. We included all ≥18 years hospitalised patients targeted by local influenza vaccination campaign reporting an influenza-like illness within 7 days before admission. We defined as cases patients RT-PCR positive for influenza and as controls those negative for all influenza virus. We used a logistic regression to calculate IVE adjusted for country, month of onset, chronic diseases and age. We included 104 A(H1N1)pdm09, 157 A(H3N2) cases and 585 controls. The adjusted IVE was 42.8% (95%CI: 6.3;65;0) against A(H1N1)pdm09. It was respectively 61.4% (95%CI: -1.9;85.4), 39.4% (95%CI: -32.2;72.2) and 19.7% (95%CI:-148.1;74.0) among patients aged 18-64, 65-79 and ≥80 years. The adjusted IVE against A(H3N2) was 38.1% (95%CI: 8.3;58.2) overall. It was respectively 7.8% (95%CI: -145.3;65.4), 25.6% (95%CI: -36.0;59.2) and 55.2% (95%CI: 15.4;76.3) among patients aged 18-64, 65-79 and ≥80 years. These results suggest a moderate and age varying effectiveness of the 2013-14 influenza vaccine to prevent hospitalised laboratory-confirmed influenza. While vaccination remains the most effective prevention measure, developing more immunogenic influenza vaccines is needed to prevent severe outcomes among target groups.
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Vaccination contre la grippe et le pneumocoque chez les malades respiratoires chroniques : carence de couverture vaccinale et d’information. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vaccine coverage in CF children: A French multicenter study. J Cyst Fibros 2015; 14:615-20. [DOI: 10.1016/j.jcf.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
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Characteristics of patients and physicians correlated with regular influenza vaccination in patients treated for type 2 diabetes: a follow-up study from 2008 to 2011 in southeastern France. Clin Microbiol Infect 2015; 21:930.e1-9. [PMID: 26119723 DOI: 10.1016/j.cmi.2015.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/23/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
We studied a cohort of 110 823 patients treated with oral hypoglycaemic agents for type 2 diabetes in southeastern France from 1 January 2008 to 31 December 2011, to identify influenza vaccination coverage trends and the patient and physician correlates of influenza vaccine (IFV) uptake. We used French national health insurance fund (NHIF) databases to identify these patients and collect data on their IFV reimbursement claims (IFVC) and patient and physician characteristics. We used multilevel multivariate polytomous logistic regressions to test the correlates of IFVC. Between 2008 and 2011 the annual IFVC rate varied from 33.7% to 32.3% in the 18-64 age group and from 69.5% to 61.1% in the 65 + age group, among whom we saw a clear trend towards reduced vaccination after 2008. In the younger group, the probability of regular vaccination each year from 2008 to 2011 increased with diabetes severity and duration, comorbidities, and the number of general practitioner and nurse visits; it was higher among patients seeing endocrinologists and lower among low-income patients than in other patients. In the older group, there was no association with either diabetes severity or physician specialty. These results suggest different patterns of correlates of influenza vaccination according to age. Endocrinologists might help to improve IFV uptake in the younger group of patients with type 2 diabetes. Communication strategies regarding influenza vaccination should be adapted to age, and collaboration between healthcare professionals should be reinforced to achieve vaccination objectives for these patients.
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Impaired sperm motility in HIV-infected men: an unexpected adverse effect of efavirenz? Hum Reprod 2015; 30:1797-806. [DOI: 10.1093/humrep/dev141] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/26/2015] [Indexed: 12/25/2022] Open
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Low immunogenicity of quadrivalent meningococcal vaccines in solid organ transplant recipients. Transpl Infect Dis 2015; 17:322-7. [DOI: 10.1111/tid.12359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/27/2014] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
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2012/13 influenza vaccine effectiveness against hospitalised influenza A(H1N1)pdm09, A(H3N2) and B: estimates from a European network of hospitals. ACTA ACUST UNITED AC 2015; 20. [PMID: 25613779 DOI: 10.2807/1560-7917.es2015.20.2.21011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
While influenza vaccines aim to decrease the incidence of severe influenza among high-risk groups, evidence of influenza vaccine effectiveness (IVE) among the influenza vaccine target population is sparse. We conducted a multicentre test-negative case-control study to estimate IVE against hospitalised laboratory-confirmed influenza in the target population in 18 hospitals in France, Italy, Lithuania and the Navarre and Valencia regions in Spain. All hospitalised patients aged ≥18 years, belonging to the target population presenting with influenza-like illness symptom onset within seven days were swabbed. Patients positive by reverse transcription polymerase chain reaction for influenza virus were cases and those negative were controls. Using logistic regression, we calculated IVE for each influenza virus subtype and adjusted it for month of symptom onset, study site, age and chronic conditions. Of the 1,972 patients included, 116 were positive for influenza A(H1N1)pdm09, 58 for A(H3N2) and 232 for influenza B. Adjusted IVE was 21.3% (95% confidence interval (CI): -25.2 to 50.6; n=1,628), 61.8% (95% CI: 26.8 to 80.0; n=557) and 43.1% (95% CI: 21.2 to 58.9; n=1,526) against influenza A(H1N1) pdm09, A(H3N2) and B respectively. Our results suggest that the 2012/13 IVE was moderate against influenza A(H3N2) and B and low against influenza A(H1N1) pdm09.
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Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up. Orthop Traumatol Surg Res 2014; 100:S305-9. [PMID: 25129704 DOI: 10.1016/j.otsr.2014.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. OBJECTIVE To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. MATERIAL AND METHOD A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. RESULTS Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). DISCUSSION Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. LEVEL OF EVIDENCE IV - Multicenter retrospective study.
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Validity of self-reported vaccination status among French healthcare students. Clin Microbiol Infect 2014; 20:O1152-4. [PMID: 25040583 DOI: 10.1111/1469-0691.12759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/25/2014] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
Data on validity of self-reported vaccinations are scarce. This study, performed on healthcare students in Paris (France), aimed to evaluate this validity for occupational vaccinations. The validity of self-reported vaccination status was compared with written information. A total of 432 students were enrolled. Sensitivity rates for BCG, hepatitis B and measles were over 74%. For diphtheria-tetanus-polio and pertussis, sensitivity was below 50%. Specificity was between 70 and 95% for dTP-pertussis, and below 35% for all others. Overall, the validity of self-reported information was low, meaning that checking medical records remains the preferable strategy for assessing immunization status.
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Determinants of measles seroprevalence among pregnant women in Paris, France. Clin Microbiol Infect 2014; 20:O501-4. [DOI: 10.1111/1469-0691.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/05/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
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Impact of free on-site vaccine and/or healthcare workers training on hepatitis B vaccination acceptability in high-risk subjects: a pre-post cluster randomized study. Clin Microbiol Infect 2014; 20:1033-9. [PMID: 24850059 DOI: 10.1111/1469-0691.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 12/16/2022]
Abstract
Despite recommendations for adults at high-risk of hepatitis B virus (HBV) infection, HBV vaccine uptake remains low in this population. A pre-post randomized cluster study was conducted to evaluate the impact of on-site free HBV vaccine availability and/or healthcare worker training on HBV vaccination acceptability in high-risk adults consulting in 12 free and anonymous HIV and hepatitis B/C testing centres (FATC). The FATC were randomly allocated into three groups receiving a different intervention: training on HBV epidemiology, risk factors and vaccination (Group A), free vaccination in the FATC (Group B), both interventions (Group C). The main outcomes were the increase in HBV vaccination acceptability (receipt of at least one dose of vaccine) and vaccine coverage (receipt of at least two doses of vaccine) after intervention. Respectively, 872 and 809 HBV-seronegative adults at high-risk for HBV infection were included in the pre- and post-intervention assessments. HBV vaccination acceptability increased from 14.0% to 75.6% (p <0.001) in Group B and from 17.1% to 85.8% (p <0.001) in Group C and HBV vaccine coverage increased from 9.4% to 48.8% (p <0.001) in Group B and from 11.2% to 41.0% (p <0.001) in Group C. The association of training and free on-site vaccine availability was more effective than free on-site vaccine availability alone to increase vaccination acceptability (ratio 1.14; from 1.02 to 1.26; p 0.017). No effect of training alone was observed. These results support the policy of making HBV vaccine available in health structures attended by high-risk individuals. Updating healthcare workers' knowledge on HBV virus and its prevention brings an additional benefit to vaccination acceptability.
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Factors associated with humoral immune response to pandemic A/H1N1(v) 2009 influenza vaccine in cystic fibrosis. Vaccine 2014; 32:4515-4521. [PMID: 24950362 DOI: 10.1016/j.vaccine.2014.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/28/2014] [Accepted: 06/06/2014] [Indexed: 11/25/2022]
Abstract
Influenza vaccination is recommended in cystic fibrosis patients. The objective of this study was to assess the immunogenicity of vaccination against 2009 pandemic A/H1N1 influenza and to study the factors associated with the immune response in patients with cystic fibrosis. 122 patients with cystic fibrosis were enrolled in a prospective study and received 1 dose of 2009/H1N1v adjuvanted vaccine, or for children <2 years and lung-transplanted patients, two doses of non-adjuvanted 2009/H1N1v vaccine administered 21 days apart. Hemagglutination inhibition antibodies were assessed before and 21 days after vaccination and at least 6 months after vaccination. After vaccination, 85% of the patients had an influenza antibody titer ≥1:40 and 69% seroconverted. 13% of the transplanted patients seroconverted compared with 72% of the non-transplanted patients. In this latter group, non-adjuvanted vaccine and low body mass index were independently associated with lower response to vaccination. 86% of the non-transplanted patients with normal BMI and receiving adjuvanted vaccine seroconverted. Persistence of seroprotection 10 months after vaccination was found in 50% of the patients. In patients with cystic fibrosis, malnutrition and receipt of non-adjuvanted vaccine were associated with lower immune response to pandemic influenza vaccination. Our data also suggest a potential defect in the immune response to influenza vaccination of patients with cystic fibrosis and raise the question of whether a different immunization strategy is needed.
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T-07: VAC-3S, un nouveau vaccin immunothérapeutique de l’infection VIH-1 : résultats de la phase I. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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142 Immunisation coverage in children with cystic fibrosis: a French multicenter survey. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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