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Objective: Monitoring of vaccination coverage rates (VCRs) is essential to assess the implementation of a country's vaccine policy and its effectiveness. Through the French Vaccinoscopy study, we measured the evolution of VCRs as well as mothers' opinion towards vaccination between 2008 and 2018, before and after implementation of infant mandatory vaccination extension., Methods: This is a study based on an internet-standardised questionnaire. In 2018, a representative sample of 3000 mothers of infants 0 to 35 months of age answered on their opinion on vaccination and reported all vaccinations recorded in their child's health record., Results: On the period considered, infant VCRs were stable and high for diphtheria, tetanus, poliomyelitis, pertussis and pneumococcus components and progressed for measles, mumps rubella, 2 doses at 24 months of age from 45.3% in 2008 to 81.0% in 2018, hepatitis B (HepB) complete primovaccination at 6 months of age from 45.9% in 2008 to 86.3% in 2017 and 95.5% in 2018, and meningococcus C (MenC) 1 dose at 6 months of age from 43.0% in 2017 to 74.2% in 2018. In 2018, 69.0% of mothers were in favour of vaccination while this rate dropped from 80.2% in 2012 to 64.0% in 2017, and 80.8 to 89.6% perceived HepB, MenC measles and pertussis vaccinations as useful/essential, percentages in progress versus 2017., Conclusion: Following the implementation of infant mandatory vaccination in 2018, proportion of mothers in favour of vaccination increased significantly. HepB and MenC VCRs significantly progressed between 2017 and 2018., (Copyright © 2020 GlaxoSmithKline Biologicals S.A. Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMDC), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children., Methods: This annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record., Results: MenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age., Conclusions: VCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group., (Copyright © 2019 GlaxoSmithKline Biologicals SA. Published by Elsevier Masson SAS.. All rights reserved.)

Background: In a context of suboptimal vaccination coverage and increasing vaccine hesitancy, we aimed to study morbidity and mortality in children related to missing or incomplete meningococcal C and pneumococcal conjugate vaccines., Methods: We conducted a prospective, observational, population-based study from 2009 to 2014 in a French administrative area that included all children from age 1 month to 16 years who died before admission or were admitted to an intensive care unit for a community-onset bacterial infection. Vaccine-preventable infection was defined as an infection with an identified serotype included in the national vaccine schedule at the time of infection and occurring in a non- or incompletely vaccinated child. Death and severe sequelae were studied at hospital discharge. Frequencies of vaccine-preventable morbidity and mortality caused by meningococcus and pneumococcus were calculated., Results: Among the 124 children with serotyped meningococcal (n = 75) or pneumococcal (n = 49) severe infections included (median age 26 months), 20 (16%) died and 12 (10%) had severe sequelae. Vaccine-preventable infections accounted for 18/124 infections (15%, 95% CI 9, 22), 5/20 deaths (25%, 95% CI 9, 49), and 3/12 severe sequelae cases (25%, 95% CI 0, 54). The vaccine schedule for meningococcal C and pneumococcal conjugate vaccinations was incomplete for 71/116 (61%) children targeted by at least one of these two vaccination programs., Conclusions: Mortality and morbidity rates related to vaccine-preventable meningococcal or pneumococcal infection could be reduced by one quarter with better implementation of immunisation programs. Such information could help enhance the perception of vaccine benefits and fight vaccine hesitancy., (© 2018 John Wiley & Sons Ltd.)

In February and March 2016, four cases of serogroup B invasive meningococcal disease (IMD) occurred over 3 weeks in a small area north of Lyon in the Auvergne-Rhône-Alpes region, France. There were no deaths but two cases had sequelae. This community outbreak was caused by a rare meningococcal strain of the clonal complex ST-32, covered by the 4CMenB/Bexsero vaccine. The incidence rate for serogroup B IMD in this area was 22.5 per 100,000 inhabitants, which is above the epidemic threshold (10/100,000). The number of cases observed was significantly higher than expected in the age group of 0-24 year-olds (standardised incidence ratio: 96). These results suggested the potential emergence of this invasive strain in this sub-population. In accordance with French recommendations, it was decided to vaccinate the population aged between 2 months and 24 years, living, working or studying in the epidemic area. The vaccination campaign took place from April to September 2016. Vaccination coverage was estimated at 47% for one dose and 40% for two doses. The lowest coverage estimations were observed for the age groups younger than 3 and 15-19 years. Enhanced epidemiological and microbiological surveillance reported a fifth case in June 2016, outside the epidemic area.

Meningococcal vaccines in france. In France in 2015, several vaccines against invasive meningococcal disease (IMD) are available: non-conjugated polysaccharide vaccines (bivalent AC and tetravalent ACYW135) conjugate vaccines (monovalent A monovalent C and quadrivalent ACYW135) and a novel multicomponent meningococcal B vaccine. These vaccines have a very satisfactory safety profile. Currently in France, universal vaccination against serogroup C meningococcal disease is recommended for all infants at the age of 12 months with catch up till the age of 24 years. Vaccination against IMD B and C are also recommended to persons with specific individual risk factors (mainly asplenia, complement deficiency, hematopoietic stem cells) or travel in endemic areas. Despite recommendations, vaccination coverage remains below recommended levels in most of the targeted populations., Competing Interests: S. Kernéis déclare avoir été prise en charge lors de congrès par Pfizer vaccins. H. Coulange-Bodilis déclare avoir été prise en charge lors de congrès par Pfizer vaccins. O. Launay déclare des interventions ponctuelles pour Pfizer, GSK et MSD et avoir été prise en charge lors de congrès par Pfizer et GSK.

(1) Invasive infections due to serogroup B meningococci can be life-threatening. Antibiotics are not always effective. Vaccines available in France do not protect against serogroup B meningococci. (2) In the French region of Normandy, a vaccine manufactured by the Norwegian National Institute of Public Health and directed against serogroup B meningococci. (2) In the French region of Normandy, a vaccine manufactured by the Norwegian National Institute of Public Health and directed against a meningococcal strain related to the strain circulating in this region has been used since summer 2006 to protect children over one year of age and adolescents. (3) A review of the 16 available immunogenicity studies shows that immunogenicity is similar in children and adults when the vaccine is administered in two doses, six weeks apart. The manufacturing process was modified in 1995, and the new vaccine could be less immunogenic: three doses provided results similar to those obtained with two doses of the older vaccine. This implies that, in epidemic situations, the maximum protection conferred by the vaccine would be reached 3 to 4 months after beginning vaccination. (4) A double-blind placebo-controlled trial conducted between 1988 and 1991 included 171 800 adolescents aged 14 to 16 years who received two doses of the meningitis B vaccine, or placebo injections. During 29 months of follow-up, 12 invasive infections due to serogroup B meningococci occurred in the vaccine group, versus 24 cases in the placebo group. The protection rate was 57% but the confidence interval was very wide (21% to 78%). A correlation was established between the bactericidal antibody titre and clinical protection. (5) In this trial, the adverse events studied in 877 adolescents were infrequent: less than 4% of local adverse events, and about the same proportion of systemic adverse events (headache, nausea, fatigue, malaise), led to taking time off school. (6) Too few data are available for infants. And it is difficult to extrapolate to other countries the results obtained in Norway 10 years ago with a vaccine that was manufactured differently and may be more immunogenic. (7) In practice, vaccination with the Norwegian vaccine is justified in areas where an epidemic strain closely related to the vaccine strain is circulating, even though only about 60% of vaccinees are protected after three doses.

Objective: To estimate the willingness of parents in France and Germany to pay for meningococcal conjugate vaccines for their teenage children., Methods: A conjoint analysis survey was administered to parents who had received counselling on the nature and risks of meningococcal disease in young people. In each country, half were randomly assigned to view a video with graphical depictions of the effects of meningococcaemia. Subjects were then shown a series of 18 sets of three vaccine descriptions. Each description listed the price of a hypothetical vaccine (range 15-304 euro; 2001 values), the duration of protection, and the number of serogroups of the bacteria covered. The survey asked which vaccine they preferred and whether they would buy it. Conditional logit and generalised linear-random effects logit models assessed the effect of product attributes, personal background and video viewership on the probability of indicating a purchase., Results: 92.6% of subjects would purchase at least one of the vaccines they encountered. Price elasticity ranged from -1.20 (France) to -2.48 (Germany). Exposure to graphical depictions of disease consequences negligibly increased the overall willingness to purchase vaccine in French participants, but lowered the overall willingness in German participants., Conclusion: In Germany and France, where there is still limited out-of-pocket health spending, the majority of sampled respondents stated that they would purchase meningococcal vaccines with their own money.

Between January 2003 and June 2005, an outbreak of meningococcal disease occurred in the department of Seine-Maritime in northern France. Eighty six cases were notified, giving an average annual incidence of 2.7 cases per 100,000 inhabitants, compared with 1.6 in France. An especially affected area was defined as the city of Dieppe and its surrounding area (26 cases, giving an annual incidence of 12 cases per 100,000). This outbreak was due to N. meningitidis phenotype B:14:P1.7,16 belonging to the clonal complex ST-32/ET-5. Over the 31 B14:P1.7,16 cases confirmed by phenotyping methods at the national reference centre for meningococci (CNR, Centre National de Reference des meningocoques) the case-fatality rate (19%) and the proportion of purpura fulminans (42%) were especially high. Teenagers aged between 15 and 19 years and children aged 1 to 9 years were the most affected. In 2003, health authorities put in place enhanced epidemiological surveillance and informed practitioners and population about the disease. In 2004, the national vaccination advisory board studied the opportunity of using a non licensed outer membrane vesicle vaccine developed in Norway which may be effective against the B14:P1.7,16 strain. The Ministry of health decided in 2006 to offer vaccination with this vaccine to people aged 1 to 19 years in Seine-Maritime.

Capsule switching in Neisseria meningitidis is thought to occur by horizontal DNA exchange between meningococcal strains. Antigenic variants may be generated by allelic replacement of the siaD gene; the variants may then be selected by specific immunity against the capsular antigen. There were several vaccination campaigns against serogroup C in France in 2002, following an increase in the prevalence of invasive isolates of serogroup C of the phenotype C:2a:P1.5 and C:2a:P1.5,2 belonging to the ET-37/ST-11 clonal complex. We evaluated the emergence of capsule variants by the detection of B:2a:P1.5 and B:2a:P1.5,2 meningococcal isolates of the ET-37/ST-11 clonal complex. These isolates were significantly more frequent after the year 2002. Pulsed field gel electrophoresis profiles of the serogroup B (ET-37/ST-11) isolates differed from that of serogroup C (ET-37/ST-11) isolates by the bands that harbor the siaD genes responsible for the serogroup specificity. However, serogroup B and C, ET37/ST-11 isolates both express similar virulence as assessed from colonization and invasiveness in a mouse model. Our results indicate that capsule switching events within the same clonal complex can arise frequently with no alteration in virulence. This justifies an enhanced system of surveillance by molecular typing of such isolates, particularly after serogroup-specific vaccination.

Objective: In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis., Study Design: Update article., Data Synthesis: For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections.

Background: In October 2002, the Midi-Pyrenees centre of pharmacovigilance (Southwest of France) was in charge of an extensive pharmacovigilance follow-up of a campaign of meningococcal serogroup C vaccination performed in the Hautes-Pyrénées area., Objective: The purpose of this study was to evaluate the incidence, nature and seriousness of adverse drug reactions (ADRs) occurring during the 15 days after vaccination., Methods: 'Immediate' and 'late' ADRs were recorded., Results: Local immediate ADRs were mainly nonserious local or inflammatory responses with a favourable evolution. General immediate ADRs occurred in 198 subjects and were principally neurological in nature (54%, mainly headache). Moreover, 1529 subjects suffered from general late ADRs (i.e. general health status or neurological [headache] ADRs [41%]). The incidence of ADRs leading to hospitalisation or medical consultation was defined as 'very rare' (0.1% led to consultation and 0.03% to hospitalisation)., Conclusion: These results underline that most of the ADRs occurring during the 15 days after meningococcal serogroup C vaccination were benign. This study shows that the methods used in France for pharmacovigilance studies of drugs can also be used for vaccines, especially for an intensive and prospective survey. Further pharmacoepidemiological studies could be used after the pharmacovigilance survey to investigate the benefit/risk ratio in large populations.

This article is the full-length text (including arguments and recommendations) written by the Conseil Supérieur d'Hygiène Publique de France, in its session of march 8th 2002, expressing its opinion on the immunization policy with the heptavalent pneumococcal conjugate vaccine (Prevenar).