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Objective Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. Through Vaccinoscopie survey, we measured for the second consecutive year the impact of this new policy on vaccine coverage rates (VCRs) and mothers’ perception regarding vaccination. Methods Web-based survey on a representative sample of 1500 mothers of 0 to 17-month-old infants. Results Non-optimal VCRs continued to increase in 2019 versus 2017 (according to age, + 7 to 8 points VCR for Hepatitis B and + 36 to 68 points for Meningococcus C). After a progressive decrease between 2012 and 2017, the rate of favorable mothers’ opinion towards vaccination continued to progress in 2018 and 2019. Conclusion These results confirmed the positive impact of this new law on infant VCRs and mothers’ favorable opinion regarding vaccination.

International audience

Objectives Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMD C), 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.

International audience; OBJECTIVE: In France infant vaccines protecting against 11 diseases have changed from a recommended to a mandatory status for all children born on or after January 1, 2018. Using the Vaccinoscopie survey, we measured the impact of this new vaccination policy on vaccine coverage rates (VCRs) and on mothers' perception of vaccination.METHODS: Online survey with 1000 mothers of 0- to 11-month-old infants.RESULTS: VCRs for at least one dose at the age of 6 months strongly progressed for diseases that previously did not meet Public Health objectives (+8 points for Hepatitis B and +31 points for meningococcal C vaccines). Mothers were more favorable to mandatory vaccination and better informed in 2018 than in 2017.CONCLUSIONS: These first results showed a positive impact of the extension of mandatory vaccination on mothers' opinion regarding vaccination and on infant VCRs.; Objectifs: En France, pour les enfants nés depuis le 1er janvier 2018, les vaccins du nourrisson protégeant contre 11 maladies, auparavant recommandés, sont devenus obligatoires. L’enquête Vaccinoscopie permet de mesurer l’impact de cette nouvelle politique vaccinale sur les couvertures vaccinales (CV) et l’opinion des mères sur la vaccination.Méthodes: Étude réalisée sur Internet par questionnaire auto-administré auprès de 1000 mères de nourrissons âgés de 0–11 mois.Résultats: Les CV pour au moins une dose à l’âge de 6 mois ont fortement progressé pour les valences qui n’atteignaient pas les objectifs de santé publique (+8 points pour l’hépatite B et +31 points pour le méningocoque C). Les mères étaient plus favorables à la vaccination obligatoire et mieux informées en 2018 qu’en 2017.Conclusion: Ces premiers résultats montrent un impact positif de l’extension de la vaccination obligatoire sur les CV du nourrisson et sur l’opinion des mères quant à la vaccination.

Successive implementation of seven-valent then 13-valent pneumococcal conjugate vaccines (PCVs) led to a marked decrease in pneumococcal disease burden, including pneumococcal meningitis. We assessed the long-term effect of implementation of PCVs on incidence of pneumococcal meningitis in children in France over a 16-year period.We did a quasi-experimental, population-based interrupted time-series analysis with a nationwide prospective survey over 16 years in France, recruiting children aged younger than 15 years from 227 paediatric wards from January, 2001, to December, 2016. The main outcome by the time-series model was the estimated incidence of pneumococcal meningitis per 100 000 children (of a population of 12·6 million children in 2017) before and after PCV7 and PCV13 implementation. The time-series model was based on segmented regression with autoregressive error.We enrolled 1778 children with pneumococcal meningitis. PCV13 implementation led to a significant reduction in monthly incidence of pneumococcal meningitis from 0·12 per 100 000 children before PCV13 to a nadir of 0·07 in December, 2014 (-38%, 95% CI -56·1 to -20·4; p0·0001). A sharp increase occurred during 2015 and 2016, (+2·3% per month, incidence of 0·13 per 100 000 children at the end of the study period, p=0·0002), mainly related to an increase of serotype 24F, which was frequently penicillin resistant.The early effect of PCV13 implementation greatly reduced the incidence of pneumococcal meningitis in children less than 15 years old. However, a sharp rebound in incidence linked to the emergence of serotype 24F compromised the long-term PCV efficacy. If confirmed in future studies and in other countries, pneumococcal meningitis incidence rebound and 24F emergence should be considered when developing next-generation PCVs.The French Pediatric Infectious Diseases Group, Association Clinique et Thérapeutique Infantile du Val de Marne, Pfizer, and for the National Reference Centre for Pneumococci, the French National Health Agency.

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare cause of lymphadenopathy in children. This benign disease can mimic lymphoma and misleads doctors. It was first described in Asia, where it occurred especially in young women. Recent publications show that it can also affect teenagers and young adults in Caucasian populations. The pathophysiology remains unknown. Three hypotheses have been raised for this disease: the role of viruses (in particular HHV-8), genetic predisposition (two alleles in HLA class II genes were found more frequently in patients with Kikuchi disease), and an autoimmune cause because of the correlation with lupus erythematosus. Few cases have been reported in Europe so far. In this article, we report three cases of Kikuchi disease observed in less than 2 months in a single hospital in France. All three patients were teenagers who presented with lymphadenopathy, either isolated or combined with fever, weakness, and weight loss. In all of them, the hypermetabolic activity of the lymph node on the PET scanner misled us to suspect lymphoma. The diagnosis of Kikuchi disease was finally made, for all patients, after 2 weeks in the hospital based on lymph node biopsy. Based on this report, we highlight that early biopsy in presence of lymphadenopathy can avoid unnecessary extensive investigations. Moreover, in this rare disease, it is very surprising to come across three cases that are not family-related, in such a short period of time. This strengthens the hypothesis of the possible implication of an environmental factor in the pathophysiology of Kikuchi disease.

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.

Objective Vaccination of pregnant women against seasonal influenza is recommended in France since 2010. We currently do not have any vaccination coverage (VC) data to assess the implementation of this recommendation. Methods Vaccinoscopie ® is an annual study conducted online using a self-administered questionnaire. A section dedicated to parents’ vaccination was included in 2014 and aimed at interviewing 300 mothers of infants aged Results While 56% of mothers reported to have been informed of the importance of vaccination by a healthcare professional (HCP) during their last pregnancy, only 11% reported having been informed of the importance of influenza vaccination. Overall, 49% of mothers reported willing to be vaccinated during their next pregnancy to protect their baby, if the vaccination were to be recommended by a HCP. However, this rate was only 32% for influenza vaccination. In contrast, 52% of mothers reported willing to be vaccinated against pertussis during pregnancy if the vaccination were to be recommended by a HCP. The influenza VC estimates in pregnant women was 7%. Conclusion Although influenza vaccination has been recommended for all French pregnant women for the past five years, HCPs rarely recommend this vaccination – hence, the low VC. Informing and raising awareness among HCPs seems to be crucial to improve this coverage.

Resume L’evaluation repetee des couvertures vaccinales (CV) est essentielle pour mesurer l’application et l’efficacite d’une politique vaccinale. Nous rapportons les CV chez le nourrisson de l’etude Vaccinoscopie ® 2014 afin d’evaluer les changements secondaires a l’introduction du calendrier vaccinal 2013. Methodes Etude realisee sur Internet aupres d’un echantillon representatif de meres reportant les vaccinations du carnet de sante de leurs enfants. Resultats La suppression de la dose de DTCaP-Hib a l’âge de 3 mois a ete rapidement adoptee puisqu’en 2014 seulement 1 % des enfants de 6 mois avaient recu 3 doses de DTCaP contre 96 % en 2012. La dose de rappel etait administree plus precocement pour les valences DTCaP et hepatite B. La suppression de la vaccination ROR des 9 mois pour les enfants en collectivite a ete bien suivie puisque seulement 2 % des 9–11 mois avaient recu ce vaccin en 2014 contre 33 % en 2012. La recommandation d’une 2 e dose de ROR a 16–18 mois plutot qu’entre 13 et 24 mois a ete suivie d’une administration plus precoce de cette dose. A 18–20 mois, 60 % avaient recu 2 doses de ROR en 2014 contre 41 % en 2012. Pour la vaccination anti-meningocoque, nous avons observe une nette progression de la CV chez les 15–23 mois (66 % en 2014 contre 44 % en 2012). Conclusion La simplification du calendrier vaccinal pour le nourrisson a ete rapidement appliquee et a obtenu une excellente adhesion des professionnels de sante. Toutefois, cette mesure seule n’est pas encore suffisante pour atteindre les objectifs de CV definis par le Haut conseil de la sante publique (HCSP).

Objective Pediatricians are well aware of the immediate risks of bacterial meningitis in children. However, the long-term outcome of the disease has not been extensively studied. We aimed: (i) to evaluate the duration and quality of the long-term follow-up of children diagnosed with bacterial meningitis in a general pediatric department, (ii) to estimate the incidence of sequelae at the various stages of follow-up, and (iii) to compare our data with that of other studies. Methods We conducted a retrospective study and included 34 children (3 months–15 years) who had been hospitalized for bacterial meningitis in the pediatric department of a University Hospital between January 1st, 2001 and December 31st, 2013. Results Overall, 32% of patients presented with sequelae and 15% with seizures. Only one patient presented with hearing loss, but 23.5% of patients did not have any hearing test performed. Seven patients had a neuropsychological assessment performed and no severe neuropsychological sequela was observed in this group. The average follow-up duration increased during the study period (from 23 to 49 months). The long-term follow-up modalities observed in other studies were highly variable. Assessing the incidence and severity of sequelae was therefore difficult. Conclusion A standardized follow-up should be implemented by way of a national surveillance network of children presenting with bacterial meningitis.

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

Summary: Invasive meningococcal disease (IMD) is life-threatening and can result in severe sequelae. In France, no data have been published on the costs of severe IMD cases. Two realistic scenarios were developed with national experts (clinicians and social workers): a 6-year-old child with purpura fulminans with amputation of both legs below the knee (case A) and a 3-year-old with meningitis and severe neurological sequelae (case B). Additional scenarios included other typical sequelae of IMD such as chronic kidney disease (CKD), profound deafness and epilepsy. Data on healthcare, disability, educational and other resource use were obtained from experts and families of patients with similar sequelae. Unit costs (2013) were mainly obtained from the literature and the National Health Insurance (NHI). Time horizon was based on life expectancies of patients (77 and 55 years, respectively). A 4% discount rate decreasing to 2% after 30 years was applied. Costs are presented from the perspective of the NHI, publicly funded organizations and patients’ families or their private health insurances. purpura fulminans with amputations is associated with a lifelong discounted cost of €768,875. Adding CKD doubles the amount (€1,480,545). Meningitis with severe neuro-cognitive sequelae results in a lifelong discounted cost of €1,924,475. Adding profound deafness and epilepsy slightly increases the total cost (€2,267,251). The first year is the most expensive in both scenarios (€166,890 and €160,647 respectively). The main cost drivers for each scenario are prostheses and child/adult stays in healthcare facilities, respectively. Overall, patients’ families or his private insurance had to pay around 13% of total cost (101,833€ and 258,817€, respectively). This study fills a gap in the body of knowledge on IMD sequelae care and lifetime costs in France. The potentially high economic burden of IMD, in addition to its physical, psychological and social burden, reinforces the need for prevention. Keywords: Invasive meningococcal disease, Management, Cost, Prevention, France

International audience; Background: The incidence of meningitis caused by Klebsiella pneumoniae (Kp) and Klebsiella oxytoca (Ko) in high-income countries is unknown, and no series have been published to date.Methods: We conducted a nationwide multicenter observational study in France between 2006 and 2016. All children from the French national registry for paediatric bacterial meningitis under the age of 1 year and hospitalized for Kp or Ko meningitis were included. Virulence factors of four Klebsiella spp. strains were explored by whole genome sequencing.Results: Of 1859 cases of meningitis in children under the age of 1 year, 13 cases (0.7%) of Klebsiella spp. meningitis (nine for Kp meningitis and four for Ko meningitis) were registered in the French national registry. Three of the patients died and 50% of the survivors had developmental delays.Conclusions: Prematurity, low birth weight, and congenital anomalies of the urinary tract appear to be risk factors for Klebsiella spp. meningitis as well as virulence factors of the strain.

Infectious diseases are constantly evolving for many reasons. New infectious agents are regularly discovered, mainly because of the development of identification methods, including the molecular tools and mass spectrometry. Changes in the epidemiology of infectious diseases are not always understood, but several factors undoubtedly play an important role, notably the impact of vaccination implementations, the ecological consequences of antibiotic treatments and their excessive use, and the secular epidemiological trends of pathogenic agents. Antibiotic resistance has been recognized as one of the major challenges for humanity and few new antibiotics with potent activity against resistant Gram-negative rods have been developed in recent years. The rationalization of antibiotic treatments is a key for reducing or limiting antimicrobial resistance. This guide takes into account the latest recommendations, the consensus conferences, and the guidelines of the Pediatric Infectious Diseases Group of the French Society of Pediatric, the French Infectious Diseases Society, and French official agencies. For each clinical situation, the main bacterial target of the antibiotic treatment, the first-choice antibiotic and the alternative treatment, as well as the most important findings for the diagnosis and treatment of the infection are detailed.

Resume Objectif Apprecier le statut en vitamine D des enfants de 6 a 10 ans. Methode L’etude s’est deroulee sur deux hivers d’ensoleillement different dans 20 puis 22 centres. Trois cent enfants âges de 6 a 10 ans devaient etre inclus en fin de periode hivernale et les dosages realises sur reliquat biologique dans un laboratoire centralise. Les seuils actuellement retenus de 25 hydroxyvitamine D (25-OH-D) ont permis de definir les situations de deficit severe ou carence (≤ 25 nmol/L), de deficit (25 100 nmol/L). Un questionnaire standardise a permis de renseigner les informations connexes necessaires et les niveaux d’ensoleillement ont ete connus grâce a Meteo-France. Resultats Un dosage plasmatique de 25-OH-D a pu etre realise chez 326 enfants ; 38 % avaient recu une supplementation vitaminique D depuis la rentree scolaire. On a compte 3,1 % d’enfants en situation de carence, 34,4 % en deficit, 53,1 % en statut satisfaisant et 9,5 % avec une concentration haute sans consequence sur la calcemie et la calciurie. Une difference nord/sud a ete observee. Dans la population non supplementee ( n = 188), 5,3 % etaient carences, 45,2 % en deficit et 48,4 % avaient un taux satisfaisant. Le pourcentage de carence et de deficit etait double l’hiver le moins ensoleille. Dans la population supplementee ( n = 119), aucune carence n’a ete constatee ; 13,4 % des enfants etaient en situation de deficit et 22,7 % avaient une concentration haute sans signe de surcharge. Conclusion Un tiers des enfants presentait une concentration deficitaire en 25-OH-D. Parmi les enfants supplementes, aucun n’etait carence, peu en situation de deficit et aucun signe de surcharge n’a ete note alors que chez les enfants non supplementes la moitie (50,5 %) etait en situation de deficit en fin d’hiver. Ces resultats plaident en faveur d’une supplementation hivernale chez les enfants.

Resume Le calendrier vaccinal 2013 repondant a un objectif de simplification a efficacite comparable, a diminue le nombre d’injections recommandees et a en particulier supprime l’injection effectuee a l’âge de trois mois en population generale. En dehors de la prevention des infections invasives a pneumocoque pour laquelle il est recommande de maintenir trois doses en primovaccination, la vaccination du premature n’est pas abordee dans ce nouveau calendrier. Les grands prematures peuvent-ils beneficier de ce nouveau calendrier ou doit-on maintenir chez eux trois injections ? L’objectif de ce travail est de preciser ce point a travers les donnees disponibles dans la litterature. Les enfants nes prematurement et surtout les « grands prematures » nes avant 33 SA sont des enfants a haut risque de contracter des infections dont certaines peuvent etre prevenues par la vaccination. Pour les valences coqueluche, pneumocoque, Hib, hepatite B quels que soient les criteres d’immunogenicite retenus, elle est nettement moins bonne chez les grands prematures que chez les nouveau-nes a terme. Bien qu’il n’y ait pas de preuve clinique, ceci fait craindre que le passage a deux doses ne permette pas d’une part, de proteger suffisamment a court terme et, d’autre part, laisse craindre une moins bonne reponse immunitaire apres le rappel a 11 mois. Compte tenu de ces donnees, le GPIP prend position pour le maintien d’une primo-vaccination a 3 doses a 2,3 et 4 mois pour les prematures de moins de 33 semaines.

About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD.We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines.We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged2 years than in younger children (26% vs 3%; P.001).Children with IPD should undergo immunological investigations, particularly those aged2 years, as PIDs may be discovered in up to 26% of cases.

Resume L’evaluation repetee des taux de couverture vaccinale (CV) est essentielle pour mesurer l’application, et ainsi l’efficacite, d’une politique vaccinale afin d’apporter les corrections necessaires. L’objectif etait de mesurer l’evolution annuelle des CV entre 2008 et 2011 chez les jeunes enfants. Methodes Etude realisee sur Internet par questionnaire auto-administre aupres d’un echantillon representatif de meres reportant les vaccinations du carnet de sante de leurs enfants. Resultats La CV du DTPCa (schema complet) (diphterie [D], tetanos [T], poliomyelite [P], coqueluche [Ca]), etait de 96,0 % a 6 ans en 2010. La CV pour l’hepatite B (≥ 1 dose) chez les 6–11 mois etait passe de 54,6 % en 2008 a 80,5 % en 2011, mais seuls 34,7 % des 6 ans avaient recu un schema complet en 2010. La CV pour le vaccin antipneumococcique conjugue (schema complet) avait augmente pour atteindre 92,7 % chez les 24–35 mois en 2011. La CV du vaccin rougeole–oreillons–rubeole (ROR) (2 injections) avait augmente chez les 24–35 mois de 60,3 % en 2008 a 81 % en 2011. En 2011, 64,2 % des 24–35 mois avaient recu une deuxieme dose ROR avant 25 mois contre 45,4 % en 2008. La CV du vaccin par le bacille de Calmette et Guerin (BCG) dans la tranche 12–35 mois etait de 73,2 % en Ile-de-France, ou la vaccination est recommandee chez tous les enfants, contre 15,5 % en province ou la vaccination est ciblee sur des enfants a risque. Conclusion Cette etude montre une amelioration de la CV des jeunes enfants francais, mais les efforts d’information doivent se poursuivre et s’etendre aux adolescents et adultes dont les CV sont tres faibles.

BACKGROUND: Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. METHODS: All HIV-1-infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. RESULTS: Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load

International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (

In 2008 and 2010, the Comite technique des vaccinations and the Haut Conseil de Sante Publique have not recommended generalized vaccination against rotavirus (RV) in France. The Groupe de Pathologie Infectieuse Pediatrique (GPIP) and the Association Francaise de Pediatrie Ambulatoire (AFPA) believes that it is time to reconsider the recommendation. Indeed, on the one hand, answers were made on the presence of circovirus in vaccines and the risk of intussusception, on the other hand, these vaccines are already implemented in vaccination programs in many developing countries or countries with income intermediate and high. Finally, independent studies have demonstrated the effectiveness in countries with widespread vaccinations (without significant genotypic changes of circulating strains). In addition, implementation would have a major impact on our health care system, changes of the epidemic curve of RV infections (delayed and shortened) to prevent the coexistence of different epidemics occurring during the fall and winter. Remains medico-economic evaluation, which is not of the competence and the responsibility of GPIP and AFPA. However, it seems surprising that developing or middle-income countries have been able to generalize this vaccination and that France can't do it.

Resume Les infections favorisent jusqu’a un tiers des morts inattendues du nourrisson. Nous rapportons l’observation de 3 cas d’infections bacteriennes severes a Neisseria Meningitidis , Streptococcus Pneumoniae et Staphylococcus Aureus , chez des enfants de moins de 4 ans decedes de mort inattendue. Des prelevements bacteriologiques, peripheriques et centraux, ont permis d’isoler les bacteries en cause. Ces prelevements doivent etre realises chez un enfant decede lorsque rien dans ses antecedents ni dans l’anamnese ne pouvait laisser prevoir son deces. La recherche d’un deficit immunitaire nous parait egalement justifiee. Enfin, l’education des parents aux signes precoces d’infections bacteriennes severes nous semble indispensable.

Resume La reunion annuelle de la Societe americaine d’infectiologie (Infectious Disease Society of America [IDSA]), qui a reuni pres de 5000 congressistes de plus de 80 pays a Vancouver, Canada du 21 au 24 octobre 2010, a permis de faire le bilan de la pandemie de grippe A(H1N1) 2009 en Amerique du Nord, d’evaluer les programmes de vaccination, et de presenter les nouveaux vaccins en cours de developpement. Avec 12 500 deces aux Etats-Unis en 2009–2010, la grippe pandemique a ete moins meurtriere que la grippe saisonniere. Mais elle a frappe essentiellement des jeunes, et le bilan calcule en nombre d’annees de vie perdues est eleve. Les differents vaccins monovalents (vivants attenues, inactives avec ou sans adjuvants) ont ete bien toleres, chez les enfants comme chez les adultes et les femmes enceintes. La protection des tres jeunes nourrissons contre la coqueluche passe par le renforcement des rappels vaccinaux de son entourage familial. L’introduction du vaccin pneumococcique conjugue 13-valent au debut de l’annee 2010 pourrait resoudre – mais pour combien de temps? – le probleme de remplacement des serotypes, responsable d’une recrudescence des infections invasives a pneumocoques observee dans les pays qui avaient introduit le vaccin conjugue 7-valent. L’efficacite du vaccin rotavirus se confirme, avec une diminution des hospitalisations aux Etats-Unis et une diminution des deces dus aux gastroenterites au Mexique. Aux Etats-Unis, la vaccination des preadolescentes contre le papillomavirus humain (HPV) n’a pas entraine d’effet indesirable particulier. La vaccination de routine contre la varicelle, recommandee depuis 1995, n’a eu aucun impact sur l’evolution de l’incidence du zona. Quant au vaccin contre le zona, recommande pour les sujets de 60 ans et plus aux Etats-Unis, son efficacite sur le terrain serait de 55 %, d’apres une etude de cohorte (Kaiser Permanente de Californie du Sud). Si certains proposent l’elaboration de vaccins a la carte, en fonction des caracteristiques genetiques individuelles, la priorite reste l’augmentation de la couverture vaccinale, non seulement chez les enfants, mais aussi chez les adultes et les personnes âgees. Il convient de proposer un calendrier vaccinal etale sur toute la vie, la vaccination a l’âge adulte et chez les seniors etant determinante pour une bonne sante a tous les âges de la vie.

An 11 year old African boy without previous history was hospitalised for fever and a severe anaemia (haemoglobin = 55 g/L) with low reticulocyte count. Blood smear showed more than 35% of ghost red blood cells which allows the diagnosis of G6PD deficiency (< 1% of normal level). Anaemia was demonstrated as haemolytic and was associated with a drepanocytosis trait. Aspect of red blood cells on blood smear remains important for the diagnosis of congenital or acquired red blood cell diseases, even abnormalities are often of low specificity.

Chickenpox is often considered more severe during the first year of life, but its course is usually mild during the first 3 months of life, presumably owing to the persistence of maternal antibodies. Hospitalization and intravenous acyclovir therapy are generally restricted to severe cases but also systematically recommended in newborns in France, irrespective of the clinical severity of the infection. This recommendation was launched in 1998 when Varicella zoster virus (VZV)-specific immunoglobulins were not available in the country and has remained unchanged since. The aim of this prospective observational study was to describe complications of varicella infection in a population of 745 children hospitalized for varicella before 1 year of age, with a specific focus on newborns. Complications occurred in 65% of cases. They were very rare before the age of 1 month (10%) but their incidence then increased progressively with age and probably the disappearance of maternal antibodies: 42% (1-2 months), 66% (3-5 months), 70% (6-8 months), and 79% (9-12 months). Conclusion Chickenpox is usually mild in newborns because most of them are protected by VZV maternal antibodies. Unless the absence of maternal VZV immunity is demonstrated, newborns with mild chickenpox should not require antiviral therapy.

Tick borne encephalitis is a viral disease due to TBEV (Tick-Borne Encephalitis Virus) transmitted by infected tick-bite. It is an arbovirosis (arthropod-borne viruses). This disease is encountered in a large area from Western Europe to the eastern coast of Japan. More than 10,000 cases are hospitalized each year and cases are increasing in Europe. The risk to be infected is very high in residents of endemic areas but also in travellers who have leisure in these endemic areas. Morbidity is age dependent and is highest in adults. A third of patients have longlasting sequelae with cognitive dysfunction. Diagnostic is made by specific IgM and IgG antibody in the serum. In the first phase of illness the virus can be detected by RT-PCR from blood. No specific treatment for this disease exists. Immunization is the main preventive measure.

Children empyema pose therapeutic problems for reasons that are not clearly established. The pneumococcus is by far the bacteria most often responsible. There is no clinical study demonstrating the superiority of an antibiotic regimen over another. Even though these studies exist, they would be challenged by the evolution of bacterial resistance that may vary depending on different parameters: antibiotic pressure, vaccination etc. Therefore, it is on the microorganism suspected, the data of bacterial resistance and pharmacokinetics-pharmacodynamic (Pk / Pd) parameters that lead to antibiotic choice. An analysis of these elements can lead to the following proposals. For pneumococcal empyema, intravenous 3rd generation cephalosporin at dose of 100mg/kg/day divided 4 injections IV for cefotaxime or 50mg/kg/day in once a day for ceftriaxone. These doses are likely to be doubled in case of pneumococcus resistant to penicillin. Neither fosfomycine or aminoglycosides have a sufficient activity against pneumococcus to be offered in combination. If an association seems useful, the two best candidates are vancomycin and rifampin. For group A streptococcus empyema, clindamycin in association with is certainly the best choice. The recent evolution of resistance to macrolides should lead to check the susceptibility of the bacteria implicated. If S. aureus is susceptible to meticilline (most often), a M penicillin by parenteral route associated with an aminoglycoside is proposed. Fosfomycine can be an alternative to the aminoglycoside. If S. aureus is meticilline resistant, the association vancomycin and rifampicin seems best suited. When no bacteria has been isolated, the choice against pneumococcus resistant seems most appropriate.

Since 2004, in France, pertussis booster is recommended in parents of young infants and adults likely to become parents. This recommendation adds to others such as rubella vaccination in unvaccinated or seronegative women and decennial dT-IPV booster. The objective of this study is to evaluate the impact of these recommendations in parents of young infants. Pediatricians had to include parents of infants at the first well-baby visit after birth. Vaccination data were secondary recorded from parent's health record or called upon their memory. Between June and October 2006, 41 pediatricians included parents of 400 infants (median age: 36 days). dT-IPV booster was recorded or recalled in 37.4% within the 10 previous years and 17.7% within the 3 previous years. Among this last group, only 11.8% had received a combination including pertussis. Rubella serology was declared as positive by 94% of the mothers, but the physicians obtained the information of a previous rubella vaccination in only 71.7% of the mothers. Among the 9 seronegative mothers during pregnancy, only 3 were vaccinated in postpartum. Adults' immunization guidelines are not well known and poorly applied in France. The unavailability of monovalent pertussis vaccine reduces the eligible population. Two years after the launch of the pertussis cocoon strategy, the coverage of eligible young parents remains low and many opportunities are too frequently missed on the opportunity of decenial dTPolio booster. Rubella catch up strategy should be improved. Adults' vaccination strategies and guidelines need to be better broadcasted to health care professionals and also families.

During April 2006, 579 physicians took part in a survey about intradermal BCG SSI adverse events (AE) in children less than 6 years old, managed by InfoVac France. Since January 2006, 68% physicians (paediatricians: 73% and general practitioners [GP]: 60%) have vaccinated at least one child. The site of injection is mainly the extern side of the shoulder (72%), according to the recommendations. Systematic vaccination is continued by 54% GP and 26% paediatricians. Others indications are: admission in day care center (33%), admission in day care center associated with risk factors (24%), or only risks factors (8%). Half physicians observed AE and 6% of them reported them at pharmacovigilance centers or pharmaceutical company. AE were mainly inflammations or indurations over 1 cm (for 75% of physicians who observed AE), oozing (73%). Abscesses are notified by 54%, ulcers by 39%, lymphadenopathies over 1 cm by 20%, suppurative lymphadenopathies by 3% and keloid scares by 17% of them, several AE may coexist for some children. Our aim is to start a prospective follow-up of BCG-SSI vaccination and its AE; 58% physicians who answered this investigation agreed to participate.

The cocoon strategy against pertussis has been recommended in France since 2004 to indirectly protect young infants who are not yet vaccinated. We aimed to measure vaccination coverage among French parents of infants.A representative sample of 300 mothers and 200 fathers of infants aged12 months completed a self-administered online questionnaire. They all provided their own vaccination records.Overall, 87% of mothers believed vaccination against pertussis to be important; 83% reported being immunized against pertussis but their vaccination records showed that a third of them was wrong (34%). On the basis of our sample, the 2009-2014 vaccination coverage against pertussis among mothers increased from 22 to 61% (P0.005); over the same period of time, vaccination coverage against diphtheria, tetanus, and polio remained stable (80%). Vaccination coverage against pertussis among fathers increased from 21 to 42% between 2010 and 2013 (P=0.009). In 2013, one couple out of four (26%) was adequately immunized against pertussis.The cocoon strategy was implemented 10years ago in France but vaccination coverage remains suboptimal among parents of young infants. Healthcare professionals must recommend vaccination against pertussis to young adults and check that their vaccination status is up to date.

Reimbursement of the hexavalent vaccine (Infanrix hexa) comprising the DTPa-IPV-Hib components and the hepatitis B valence in a single vaccine was decided in March 2008 in France. The impact of its reimbursement on the hepatitis B vaccine coverage rate was assessed in a study conducted in the general population prior to and after implementation of the reimbursement policy.The PopCorn study (NCT01782794) was a national, cross-sectional and repeated study, with four assessment periods over 3 years, from 2009 to 2012, to assess the hepatitis B vaccine coverage in 12- to 15- and 24- to 27-month-old children, vaccinated between 2007 and 2011 and selected by the quota sampling method. Face-to-face interviews were conducted at their homes and vaccination status was collected using their child's health record. Parents were also interviewed on their perceptions and acceptance of hepatitis B vaccination. Three indicators were calculated to assess hepatitis B vaccination coverage: proportions of infants with at least one dose before 6 months of age, with at least two doses before 6 months of age and with a complete schedule at 24 months of age.A total of 4903 children were enrolled in the study. An overall significant increase (P-value [P0.05]) of the three indicators of interest over the four periods of time was observed for both age groups. The proportion of children receiving hepatitis B vaccination before 6 months increased from 21% at baseline (before vaccine reimbursement) to almost 75% at the last assessment period in 2012. More than 60% of 24- to 27-month-old children received a complete schedule in 2012 compared to 33% at baseline. No significant increases in the proportions of parents "favourable" and "moderately in favour" of hepatitis B vaccination were observed across the four evaluation periods (respectively, 17-22% and 48-50%, P=0.09).The rapid increase of hepatitis B vaccination coverage suggests a significant change in hepatitis B vaccination practice related to the hexavalent vaccine's reimbursement. This change was observed in a context of stability regarding parents' perceptions and acceptance of hepatitis B vaccination and of coverage rates for other infant vaccinations.

The reimbursement of the hexavalent vaccine (Infanrix hexa™), comprising the DTPa-IPV-Hib components and the hepatitis B recombinant in a single vaccine, was approved in France in March of 2008. The impact of its reimbursement on physicians' decisions to vaccinate infants against hepatitis B was assessed in a study conducted with general practitioners and pediatricians.The PRALINE study (NCT01777074) was a national, cross-sectional, repeated study with two measurement periods (T1 and T2) that measured the changes in physicians' acceptance of hepatitis B vaccination of infants before and for the 3 years after the approval of the hexavalent vaccine reimbursement. Two patient registers were created for each measurement period to enroll the first 15 12- to 15-month-old infants and the first 15 24- to 27-month-old children seen by the practitioners. The proportion of eligible children receiving a hepatitis B vaccine for each physician's practice was calculated. Practitioners also answered a vaccination practice questionnaire via telephone interviews.Across the two study periods, 418 general practitioners and 463 pediatricians were recruited and responded to the telephone interview on their vaccination practices. The overall number of children included in the study in both study periods reached almost 20,000. In the general practitioners group, there was a significant increase in the proportion of physicians "practicing hepatitis B vaccination" (i.e., at least 50% of eligible children receiving the initial hepatitis B vaccination) in children 24-27 months old (79% T2 versus 47% T1, P-value [P]0.001). Similarly, the proportion of pediatricians initiating hepatitis B vaccination increased from 51% (T1) to 94% (T2) (P0.0001). General practitioners offered hepatitis B vaccination to infants more systematically in the second study period (87% T2 versus 73% T1, P0.001) and also suggested the use of the hexavalent vaccine to more patients after reimbursement (92% T2 versus 78% T1, P0.0001). The proportion of pediatricians offering vaccination to every infant was high at T1 (94%) and remained steady (97%) with a high use of the hexavalent vaccine (94% T1 and 96% T2).The PRALINE study shows a significant and immediate change in the hepatitis B vaccination practices of general practitioners and pediatricians following hexavalent vaccine reimbursement with a significant increase in hepatitis B vaccine coverage in infants.

Resume En France, la vaccination annuelle contre la grippe est recommandee et gratuite pour les enfants atteints de certaines affections de longue duree (ALD) [affections bronchopulmonaires, cardiaques, affections renales chroniques, diabete, hemoglobinopathie, deficit immunitaire]. L'objectif fixe dans la loi de sante publique est d'atteindre un taux de couverture vaccinale grippe d'au moins 75 % d'ici 2008. A ce jour, les donnees relatives au taux de couverture vaccinale chez ces jeunes patients restent limitees. Objectif Evaluer la couverture vaccinale contre la grippe chez des enfants de la region parisienne atteints d'affections de longue duree et consultant en milieu hospitalier. Methodes Il s'agit d'une etude descriptive transversale multicentrique, menee avant la campagne 2004–2005 de vaccination antigrippale, dans 7 services pediatriques hospitaliers de la region parisienne. Ont ete inclus les enfants de 6 mois a 18 ans, atteints d'une affection de longue duree relevant de la recommandation pour la vaccination annuelle contre la grippe et disposant d'un carnet de sante permettant de verifier leur statut vaccinal. Un questionnaire individuel a permis de preciser les motifs de non vaccination. Resultats Les donnees recueillies pour 239 enfants ont ete analysees. La population etudiee etait composee de 56 % de garcons et l'âge moyen etait de 8,1 ans. Deux patients presentaient 2 ALD differentes ; 69 % etaient atteints d'hemoglobinopathie ; 16,3 % d'une affection bronchopulmonaire chronique, et 7,5 % de diabete. Le taux de couverture vaccinale contre la grippe pour la saison 2003–2004 a atteint 43,7 % (hemoglobinopathies : 55,5 % ; affections bronchopulmonaires chroniques : 12,8 %), alors qu'il n'etait que de 20,4 % en 1999. Seulement 16,4 % des parents se souvenaient avoir recu un bon de prise en charge de la Caisse nationale d'assurance maladie. Conclusion Des efforts supplementaires restent necessaires pour atteindre les objectifs fixes dans la loi de sante publique.

Resume L'evolution de l'epidemiologie de la coqueluche, l'arrivee de nouveaux macrolides, la mise a disposition de nouveaux vaccins et les modifications du calendrier vaccinal imposent une mise a jour des recommandations pour la conduite a tenir autour d'un seul et de plusieurs cas groupes de la maladie. Une attention particuliere doit etre portee au diagnostic de la coqueluche des adultes qui representent actuellement le reservoir principal de Bordetella pertussis. Ces coqueluches de l'adulte se presentent sous la forme d'une toux prolongee, a recrudescence nocturne et sont a l'origine de la plupart des contaminations des jeunes nourrissons. La mise en place de mesures de prophylaxie suppose une confirmation microbiologique du diagnostic de coqueluche. Pour les nourrissons, la culture et la PCR sont les techniques de reference, egalement applicables aux enfants et adultes qui toussent depuis moins de 20 jours. Au-dela, la serologie (Elisa et immunoempreinte) est la seule methode utilisable mais n'est interpretable qu'en cas de vaccination datant de plus d'un an. Les mesures concernant le cas comportent : une hospitalisation systematique des nourrissons âges de moins de trois mois, un isolement respiratoire et une eviction de la collectivite pendant les cinq jours suivant la mise en route d'un traitement antibiotique adapte. Celui-ci doit privilegier les « nouveaux macrolides » : clarithromycine pendant sept jours ou azithromycine pendant cinq jours. Dans l'entourage familial d'un malade, il convient de prescrire une antibioprophylaxie aux enfants et aux adolescents non a jour de leurs vaccinations ainsi qu'aux parents du sujet index et aux parents de nourrissons non ou mal vaccines. Il conviendra egalement de mettre a jour les vaccinations des sujets de l'entourage. Les memes mesures s'appliquent aux cas groupes (au moins deux cas contemporains ou successifs dans une meme unite geographique). Dans cette situation, le medecin de sante publique de la DDASS sera alerte et participera a l'investigation et la classification des cas. Les contacts proches non ou mal vaccines seront soumis a une antibioprophylaxie et une mise a jour des vaccinations. Parmi les contacts occasionnels, seuls les sujets a risque seront soumis a une antibioprophylaxie. Dans les creches, une antibioprophylaxie sera administree a tous les nourrissons ayant recu moins de quatre doses de vaccin ainsi qu'au personnel en contact avec les cas. Dans les etablissements scolaires, une antibioprophylaxie sera administree a tous les enfants de la classe ou section non a jour de leurs vaccinations ainsi qu'aux enseignants. Dans les internats et collectivites d'enfants handicapes, l'antibioprophylaxie pourra etre etendue a toute la collectivite si le taux de couverture vaccinale est inferieur a 50 %. Dans les etablissements de sante, le port systematique d'un masque est recommande pour les soignants qui toussent et la coqueluche devrait etre recherchee en cas de toux persistant au-dela de sept jours. Les mesures preventives seront appliquees en cas de coqueluche confirmee.

The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycin for seven days or azithromycin for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibiotic prophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis.

Tuberculosis remains one of the leading cause of death from infectious disease in the world. Tuberculosis control is one of the Word Health Organisation priority. One third of the population was estimated to be bacillus tuberculosis carrier responsible for 8 million of new tuberculosis cases occurring each year and nearly 2 million deaths. In Europe near 400,000 cases have been declared in 2001 with a west-east gradient in the incidence rate: 11 cases for 100,000 in west european countries, 41 per 100,000 in central european countries and 92 per 100,000 in east european countries. The number of tuberculosis cases decreased in France with an average annual decline of 7.5% between 1972 and 1988. This trend discontinued in 1989. Between 1991 and 1993 the number of reported tuberculosis increased. This excess of cases is attributable partly to HIV infection, but also to worsening in socio-economic conditions. From 1993 to 1997 the number of cases decreases again and the incidence rate is about 11 p. 100,000 and remains stable. In 2002, 6322 cases have been declared in France. There are important geographic differences. The Ile de France region has the highest incidence rate: 27.1 per 100,000. The rates of the other regions are much lower. The infection risk is different according to age, sex and nationality. People over 75 are one of the most affected age group. Children under 15 years of age represent 4.3% of cases with half of these cases before 5 years of age. As in adult, incidence rate of tuberculosis is 11 fold higher in migrants children than in french children. Less than 10 cases of tuberculous meningitis are reported annually under 15 years of age. Since 2003, mandatory notification includes tuberculous infection for children under 15 years of age. Data recorded in mandatory notification might be useful to improve tuberculosis control in France.

Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful.

Resume Les calcifications discales chez l'enfant se revelent le plus souvent par une crise douloureuse rachidienne. La localisation cervicale semble la plus frequente mais les autres localisations etant moins symptomatiques, elles passent probablement plus souvent inapercues. Un syndrome de compression medullaire ou radiculaire peut necessiter une chirurgie de decompression en urgence. Nous rapportons deux observations d’enfants hospitalises pour des calcifications discales symptomatiques. Observations. – Le premier patient a presente un torticolis a l'âge de sept ans, revelateur de la migration d’une calcification discale jusque la asymptomatique. Le deuxieme enfant a presente une protrusion discale, ayant entrainee un syndrome de compression medullaire modere, traite par traitement conservateur seul. Conclusion. – Les calcifications discales intervertebrales de l’enfant sont une pathologie rare dont l’etiopathogenie reste inconnue. Un examen neurologique attentif et eventuellement une imagerie sont necessaires lorsqu’elles deviennent symptomatiques.

A seven-valent pneumococcal polysaccharide-CRM197 carrier protein conjugate vaccine (PNC7V; Prevenar, Wyeth, Paris) targets the serotypes (belonging to serogroups 14, 6, 19, 18, 23, 9, and 4) most often responsible for invasive pneumococcal disease (IPD) among children. A randomized, controlled, double-masked study among 37,868 children in northern California (Northern California Kaiser Permanente, USA) provided a per protocol vaccine efficacy value of 97.7% against invasive pediatric IPD due to the vaccine serotypes. The PNC7V vaccine was registered by the European Agency for the Evaluation of Medicinal Products (EMEA) in October 2000; a favorable "Community Marketing Decision" under the Centralized Procedure was granted in February 2001. PNC7V was recommended for most infants by the Conseil Superieur d'Hygiene Publique de France in March 2002, on the advice of the Comite Technique des Vaccinations, as S. pneumoniae in children less than 2 years of age is the primary cause of bacterial meningitis and of mortality associated with community-acquired bacterial infections. The theoretical coverage of the vaccine towards pneumococcal invasive disease in France is about 80%, which represents one of the best serotype coverage estimates in Europe, and vaccines serotypes account for 90% of penicillin-nonsusceptible strains. Distinctive characteristics in France in terms of epidemiology, life style, and therapeutic attitudes justify a precise follow up of the consequences of the vaccination on a national level during the coming years. Hence, surveillance programs have been established: (i) to ascertain the future impact of large-scale PNC7V vaccination on invasive pneumococcal disease incidence, (ii) to follow the evolution of carriage and ecology of the pneumococcus, and (iii) to establish an active "vaccinovigilance".