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Objectives We aimed to estimate vaccine effectiveness against severe measles based on the number of vaccine doses administered and the time since last vaccination. Patients and methods We included measles cases aged at least 2 years and born since 1980 who were notified in France between 2006 and mid-2019. We considered two severity levels (moderate, severe) and calculated adjusted relative risks (aRR) using multinomial logistic regression. Results We included 10,399 cases. The risk of severe measles in two-dose vaccine recipients was 71% (aRR = 0.29 [95%CI 0.12–0.72]) and 83% (aRR = 0.17 [95%CI 0.04–0.70]) lower than in unvaccinated cases, if the time since last dose was less or more than 15 years, respectively. The risk of moderate disease followed a similar pattern. Conclusions Two-dose measles vaccination provided long-term protection against severe cases, even after vaccine failures. These findings underscore the need for compliance to the recommended measles vaccination schedule to prevent severe cases.

Proton Pump Inhibitors (PPIs) are a pharmacological class designed to reduce the acidity of gastric secretions. They are prescribed for 11 % of the children in our institution.To assess the relevance of PPI prescriptions in pediatrics.A clinical audit according to the methodology proposed by the High Authority of Health was carried out between August 27 and August 31, 2018 in the pediatric departments of our institution. The main judgement criteria were the indication of the PPI. The main guidelines are the recommendations of the European society of pediatric gastroenterology, hepatology and nutrition.Thirty patients were included. The average age was 8.6 years. The indication was compliant in 19 patients. The non-compliant indications were: two ulcer risk preventions related to the prescription of non-steroidal anti-inflammatory drugs (NSAIDs), one endoscopic biopsy, four ulcer risk preventions related to corticosteroid therapy, one hematopoietic stem cell transplantation and three mucositis.The sample of patients included in the study was representative of the pediatric population with PPIs in our institution. The non-conformities identified could be justified in some cases. Only one study reported a compliance rate for PPI indications in pediatrics in the literature. This rate, in the order of 34 %, was much lower than that found in our institution (P0.01).The respect of the latest recommendations for the prescription of PPIs is quite good. A usage sheet will be diffused to improve the practices.

Introduction Most children with eosinophilic esophagitis (EoE) are atopic, but the impact of atopy on the remission and development of EoE is still unclear. The aim of our study was to determine the impact of atopy on remission of EoE and to describe allergy tests and the choice of treatment for a cohort of EoE children in France. Methods All children diagnosed with EoE between January 2013 and June 2018 in the five pediatric centers in the northeast of France were included. Children were divided into two groups according to personal atopic disorders. Histological remission was defined on the basis of an eosinophilic count below 15 eosinophils per high-power field. Results Among the 49 children included, 38 (78%) were atopic. Allergy tests were performed for 45 children (92%). Rates of sensitization were similar in both groups: 64% had food sensitization and 64% had aeroallergen sensitization. The most commonly attempted first-line therapy was with proton pump inhibitors (63%), followed by swallowed topical steroids (STS) (18%). First-line therapy was not associated with atopic status (P = 0.88). Atopic children had a nonsignificant tendency for a higher remission rate after STS (55% vs. 0%, P = 0.24) and a higher global remission rate (54% vs. 33%, P = 0.18) compared with non-atopic children. Conclusion Allergy testing is relevant in the majority of children with EoE whether or not they have atopic disorders. Atopy seems to be associated with better response to STS. Further studies are needed to determine whether atopic status determines histological response.

Introduction La conduite des essais vaccinaux COVID-19 necessite le recrutement d’un nombre important de participants dans un delai court. Dans ce contexte, une plateforme nationale informatisee permettant l’auto-inscription de volontaires a ete mise en place. Ce concept inedit en France permet de cibler les populations correspondant aux criteres d’inclusion, d’assurer une repartition geographique et de garantir aux promoteurs, industriels ou academiques, le recrutement rapide dans les essais. L’objectif du travail presente ici est de decrire les caracteristiques des volontaires inscrits. Materiels et methodes Un appel a volontaires a ete lance le 01/10/2020 sous la forme d’une conference de presse. Il a aussi ete relaye par les medecins generalistes. Tout adulte pouvait s’inscrire sur une plateforme declaree a la CNIL accessible a partir d’un site internet contenant des informations sur le developpement des vaccins COVID-19. Le volontaire devait renseigner son identite et ses coordonnees, donner expressement son consentement puis des informations concernant : – son poids, sa taille et l’existence d’une ou plusieurs comorbidites (diabete, hypertension arterielle, maladie cardiaque et/ou respiratoire, insuffisance renale, transplantation d’organe solide, maladie auto-immune et cancer) ; – la prise d’un traitement au long cours, notamment d’un immunosuppresseur ; – son exposition a la COVID-19 (professionnel de sante, metier au contact du public) ou un antecedent de COVID-19 ; – sa participation anterieure a un essai clinique. Les donnees des volontaires inscrits entre le 01/10/2020 et le 21/12/2020 ayant donne leur consentement et dont les donnees d’identite etaient completes ont fait l’objet de cette analyse, effectuee avec le logiciel STATA®. Resultats Au total, 45503 inscriptions ont ete enregistrees, dont 44611 (98%) analysees ici. Il s’agit d’hommes dans 63% des cas (n = 28049, sexratio : 1,7); l’âge median est de 51 ans (IQR : 35-63 ans). Les personnes âgees de 65 ans et plus representent 22% (n = 9551) des volontaires; 1,2% (n = 507) ont 80 ans et plus. Au moins une comorbidite est presente chez 14609 (39%) volontaires: 16% d’obesite (n = 6054), 16,5 % d’hypertension arterielle (n = 6243), 6% de diabete (n = 2251), 6,6% de maladie cardiaque (n = 2493), 9,9% de maladie respiratoire (n = 3747), 0,4 % d’insuffisance renale (n = 160), 5,2 % de maladie auto-immune (n = 1976), 0,8% de cancer (n = 306) et 0,3% de transplantes (n = 117). Cinq pour cent (n = 2284) ont declare un antecedent de COVID-19 et 13% (n = 5654) sont des professionnels de sante. Conclusion La mise en place d’une plateforme nationale dediee aux essais vaccinaux COVID-19 est une premiere en France et a permis l’inscription d’un grand nombre de participants potentiels grâce a un fort relais par la presse nationale et un accueil positif des francais de tous les âges. Cet outil doit garantir un recrutement rapide dans les essais vaccinaux COVID-19 en cours et pourrait constituer de facon plus generale une approche efficace pour dynamiser le recrutement des essais cliniques en France.

Background To address the question if pediatric CD patients responding to nutritional induction therapy can be maintained in remission on dietary therapy without the use of immunosuppressive drugs, we designed a prospective randomized trial (CD-HOPE) comparing cyclic exclusive enteral nutrition (EEN) to daily supplement over a 12 month period. Methods CD patients (6–17 years) who successfully completed at least 6 weeks of EEN with clinical remission (wPCDAI ≤12.5) were recruited in 21 sites of the French GETAID pédiatrique between 12.2014 and 09.2018. All drug therapy had to be stopped at least 4 weeks prior to inclusion. A total of 112 patients were screened with 100 patients randomized to group A cyclic EEN (100% of caloric requirement) every 8 weeks for 2 weeks or group B daily supplementary nutrition (25% of caloric requirement). Patient stratification according to age (< 10 years or older) and previous drug exposure or not. EEN and the nutritional supplement were in form of MODULEN IBD®. Except for the two weeks of EEN in group A food access was not restricted. Primary objective was the comparison of relapse rates at 12 months (defined as a wPCDAI >12.5 at two consecutive visits) between the two groups (log-rank test per protocol). Additional analyses were performed using a multivariate regression analysis and cox model. Results 49 CD patients were randomized to group A (cyclic EEN) and 51 to group B (daily supplement) with 43/49 and 44/51 newly diagnosed patients without any previous drug exposure. Baseline characteristics were comparable between the two groups. Median age was 12 and 13 years, group A and B respectively. At the final 12 months visits a total of 25/49 patients (group A) remained in remission without disease activation compared to 12/51 patients (group B) (p=0.004) with a hazard ratio of 0.48 (0.29–0.80) (p= 0.0051). Kaplan Maier survival remission rates are shown in figure 1. Mean fecal calprotectine levels showed no significant difference between the two groups (297, 399 and 469 at month 0, 3, and 12 visits in group A and 480, 606, and 283 at month 0,3, and 12 visits in group B). Mucosal healing at M12 months was achieved in 25/49 patients (group A) and 18/51 patients (group B), with a mucosal healing rate of 52% (group A) and 33% (group B). Both treatment arms showed a significant catch-up growth. Conclusion This is first trial indicating that children/adolescents with CD responding to EEN as induction therapy can be maintained on remission with a nutritional therapy without immunosuppressors/biologics. However, daily nutritional supplement with normal access to food was not successful with a relapse rate of 76%. This study was supported by an unrestricted grant from Nestlé Health Science and sponsored by APHP.

Introduction La prise en charge medicale des problemes de sante sexuelle et des infections sexuellement transmissibles (IST) est souvent compliquee chez les jeunes ayant debute leur vie sexuelle, en raison des difficultes d’acces aux soins. Selon Sante Publique France, la population des 15–24 ans est particulierement affectee par les IST. L’objectif de cette etude etait de decrire les caracteristiques sociodemographiques des jeunes patients consultant au CeGIDD, de comparer cette population a celle des adultes, de decrire la prevalence des IST au sein de cette population ainsi que le taux de retour pour recevoir les resultats des examens. Materiels et methodes Entre 2017 et 2019, nous avons mene une etude retrospective incluant les jeunes patients consultant au sein d’un CeGIDD parisien. Un jeune patient etait defini comme un consultant âge de 18 ans ou moins. Un echec de rendu de resultat etait defini comme une personne qui n’etait pas revenue chercher ses resultats dans un delai d’1 mois. Les analyses statistiques ont ete menees a l’aide du logiciel SPSS version 22.0. Resultats Parmi les 10 262 consultants, 7,1 % (n = 733) etaient âges de 18 ans ou moins. Parmi les jeunes patients, 55,3 % (n = 405) etaient de sexe masculin, 75,8 % (n = 430) etaient nes en Europe et 80,8 % (n = 596) etaient etudiants. Les jeunes avaient des relations heterosexuelles dans 92,3 % (n = 664) des cas versus 80,0 % (n = 7511) pour les adultes (p = 0,001). Ils n’avaient aucune couverture sociale dans 15,3 % (n = 111) des cas vs 6,5 % (n = 612) pour les plus âges (p = 0,001). Ils n’avaient jamais effectue de test pour le VIH pour 79,8 % (n = 576) d’entre eux vs 29,2 % (n = 2745). Ils avaient deja eu une IST dans 4,9 % des cas (n = 34) vs 20,9 % (n = 1913) (p Conclusion Les caracteristiques des jeunes consultants en CeGIDD sont differentes des patients plus âges avec une prevalence elevee d’infection a CT. Le taux de retour pour recuperer les resultats est plus faible que pour les adultes. Des etudes complementaires doivent etre menees pour identifier les freins et ameliorer le retour et le traitement en cas de resultat positif.

Introduction Les Centres Gratuits d’Information, de Depistage et de Diagnostic (CeGIDD), crees en 2016, ont un role renforce dans la prevention, l’information du consultant, l’education a la sexualite, la mise a jour des vaccins. Ces missions ne sont pas toujours realisees de facon optimale en raison du nombre important de consultants. Dans ce contexte, une consultation de rendu assuree par une infirmiere diplomee d’etat (IDE) ayant suivi plusieurs formations dans le domaine de la prevention a debute en juin 2019. Materiels et methodes L’objectif de ce travail etait de decrire les themes abordes lors de la remise des resultats biologiques au CeGIDD et de comparer ceux abordes par une IDE a ceux abordes par les medecins. Entre le 01/09/2019 et le 01/12/2019, des auto-questionnaires ont ete remis aux consultants volontaires d’un CeGIDD a la suite de la consultation de rendu des resultats biologiques. Ils ont ete saisis sur Google Form® et des tests du Chi2 ont ete effectues pour comparer les proportions des themes abordes par l’IDE et les medecins. Resultats Sur la periode etudiee, 105 consultants ont repondu au questionnaire, l’âge median etait de 24 ans (16 a 64 ans). Parmi les 59 (56 %) consultants masculins, 28 (50 %) avaient des rapports sexuels avec des hommes. Le rendu des resultats a ete effectue par un medecin pour 48 consultants (46 %), par une IDE pour 51 (49 %), et 6 (6 %) ne savaient pas qui leur avait remis les resultats du depistage. L’accueil de l’entretien a ete juge tres satisfaisant par 38 (79 %) consultants recus par un medecin versus 49 (96 %) recus par l’IDE. La prevention des risques lies au Papillomavirus humain (HPV) a ete abordee avec 35 consultants (68 %) par l’IDE versus 14 par le medecin (29 %). Les modes de contamination par le HPV ont ete abordes avec 45 consultants (85 %) et ses risques avec 49 (94 %), la vaccination a ete proposee a 44 consultants (83 %). La notion de l’hepatite B a ete abordee 50 fois par l’IDE (98 %) et 35 fois par le medecin (73 %). Le professionnel de sante a aborde les modes de contamination par le virus de l’hepatite B (VHB) avec 71 consultants (80 %) et ses risques avec 69 (77 %), en a propose la vaccination a 75 (84 %). La notion du traitement post-exposition (TPE) a ete abordee avec 42 consultants (82 %) par l’IDE versus 12 (25 %) par le medecin. La Prep a ete abordee 17 fois par l’IDE (33 %) versus 10 fois par le medecin (21 %). En analyse univariee, la prevention des risques lies a l’HPV et au VHB, et le TPE ont ete abordes plus frequemment par l’IDE que par le medecin (p Conclusion Les consultants sont globalement satisfaits de la consultation de remise de resultats au CeGIDD qu’elle soit effectuee par une IDE ou par un medecin. Les sujets de prevention etaient plus frequemment abordes lors des entretiens avec l’IDE que lors des rendus par le medecin. Cela met en evidence l’importance du role de l’IDE dans la prise en charge globale du consultant au CeGIDD.

Introduction Le depistage systematique de Chlamydia trachomatis (CT) chez les migrants n’est pas recommande par la Haute Autorite de sante (HAS) en France ni par l’European Center for Disease Prevention and Control (ECDC). Afin d’evaluer l’interet d’integrer le depistage systematique de CT au bilan de sante des migrants, nous avons estime la prevalence du portage de CT et identifie les facteurs de risques associes chez ceux venant consulter en centre de depistage des infections sexuellement transmissibles (CeGIDD). Materiels et methodes Tous les sujets majeurs asymptomatiques consultant dans le CeGIDD d’un centre hospitalier universitaire entre janvier 2017 et decembre 2018 ont ete inclus dans l’analyse. Ceux nes en France ont ete definis comme des « non-migrants », ceux nes a l’etranger et vivant en France depuis moins d’un an comme des « primo-arrivants » et ceux vivant en France depuis plus d’un an comme « migrants de longue duree ». Le depistage de CT a ete effectue par biologie moleculaire sur des prelevements urinaires, vaginaux, oraux ou rectaux en fonction du genre et des pratiques sexuelles. Les prevalences ont ete estimees et les OR ajustes (ORa) ont ete calcules par regression logistique avec le logiciel Stata®. Resultats Sur la periode d’etude, 4948 individus dont 771 (16 %) migrants ont ete analyses. La prevalence de CT etait de 7,7 % (n = 41) parmi les « migrants de longue duree », 5,9 % (n = 14) parmi les « primo-arrivants » et 5,1 % (n = 212) parmi les « non-migrants ». Par rapport aux individus « non-migrants » le risque de portage de CT parmi les migrants etait plus eleve chez les « primo-arrivants » et chez les « migrants de longue duree », ORa = 2,50 [IC95 % : 1,19–5,24] et ORa = 2,04 [IC95 % : 1,43–2,93] respectivement. Les autres facteurs associes au portage de CT etaient : le nombre de partenaires sexuels dans l’annee precedente (ORa = 1,51 [IC95 % : 1,06–2,17] pour 6–10 et ORa = 2,47 [IC95 % : 1,44–4,23] pour > 10 partenaires), l’orientation sexuelle (ORa = 0,26 [IC95 % : 0,14–0,48] pour les hommes ayant des relations avec des hommes), l’âge (ORa = 4,48 [IC95 % : 2,35–8,56] pour les Conclusion Au vu de la prevalence plus elevee chez les personnes migrantes que chez les non-migrantes, le depistage systematique de CT devrait etre recommande chez tous les migrants, et des conseils de prevention ciblee, en particulier chez les femmes jeunes et en contexte de multipartenariat.

The ITER Cryogenic System includes three identical liquid helium (LHe) plants, with a total average cooling capacity equivalent to 75 kW at 4.5 K.The LHe plants provide the 4.5 K cooling power to the magnets and cryopumps. They are designed to operate in parallel and to handle heavy load variations.In this proceedingwe will describe the presentstatusof the ITER LHe plants with emphasis on i) the project schedule, ii) the plantscharacteristics/layout and iii) the basic principles and control strategies for a stable operation of the three LHe plants in parallel.

The cryoline (CL) systemof ITER consists of a complex network of vacuum insulated multi and single process pipe lines distributed over three different areas with a total length of about 5 km. The thermal performance of the CL system will be measured during the final acceptance tests using the ITER cryoplant and cryo-distribution (CD) infrastructure. The method proposed is based on temperature measurementsof a small calibrated cryogenic helium flow through lines. Thecryoplant will be set to establish constant pressure and temperature whereas dedicated heater and valves in the CD will be used to generate stable mass flow rate.

The ITER cryoplant is composed of helium and nitrogen refrigerators and generator combined with 80 K helium loop plants and external purification systems. Storage and recovery of the helium inventory is provided in warm and cold (80 K and 4.5 K) helium tanks.The conceptual design of the ITER cryoplant has been completed, the technical requirements defined for industrial procurement and contracts signed with industry. Each contract covers the design, manufacturing, installation and commissioning. Design is under finalization and manufacturing has started. First deliveries are scheduled by end of 2015.The various cryoplant systems are designed based on recognized codes and international standards to meet the availability, the reliability and the time between maintenance imposed by the long-term uninterrupted operation of the ITER Tokamak. In addition, ITER has to consider the constraint of a nuclear installation.ITER Organization (IO) is responsible for the liquid helium (LHe) Plants contract signed end of 2012 with industry. It is composed of three LHe Plants, working in parallel and able to provide a total average cooling capacity of 75 kW at 4.5 K. Based on concept designed developed with industries and the procurement phase, ITER has accumulated data to broaden the scaling laws for costing such systems.After describing the status of ITER cryoplant part of the cryogenic system, we shall present the economics of the ITER LHe Plants based on key design requirements, choice and challenges of this ITER Organization procurement.

The pressure head necessary for the forced convection of supercritical helium (SHe) across the ITER superconducting (SC) magnet system is generated by centrifugal-compressor type cold circulators. From the viewpoint of the cryogenic system, simulation results indicate that the main challenge of the ITER Central Solenoid (CS) operation is the peaking pressure head of SHe across the cold circulator induced during the rapid ramping of electrical current on the coils. Excess variation in pressure head will push the operation point of the rotating machine beyond the surge line in the compressor map which can trip the circulator and in the worst case result in damages. Therefore, in order to avoid the occurrence of a surge, it has been proposed to open adaptively a cryogenic valve, installed in parallel with the CS cooling channels, during the high pressure head instances. Such an action creates an additional flow channel which consequently suppresses the pressure head peak. The proposed strategy has been numerically benchmarked and tests have been performed in existing cryogenic facilities. In this paper, we will present the test results of pressure head mitigation across the cold circulator dedicated to the KSTAR CS and Poloidal Field (PF) coil cooling circuit with the main purpose of demonstrating the safe operation of the ITER CS circulator as well as cooling circuit during plasma shots. The tests were performed by progressively increasing the coil by-pass valve opening during identical PF/CS current shots and monitoring the tendency of the maximum pressure head variation across the cold circulator. Also, preliminary results of pressure head mitigation during real plasma experiments will be introduced.

Objective Guidelines have been issued in 2010 to prevent the spread of emerging extensively resistant bacteria (eXDR), but their implementation is difficult. We aimed to evaluate healthcare workers’ (HCW) knowledge and their risk perception to identify barriers to the implementation of guidelines. Methods Semi-structured interviews were conducted at a University Hospital, where case patients are regularly admitted. The interviews focused on HCW's knowledge, risk perception, and challenges met. The evaluation of HCW's knowledge and contagiousness and perception of severity of eXDR carriage were analyzed statistically. Risk perception and opinion about guidelines were analyzed by qualitative description. Results One hundred and twenty-one HCWs were interviewed. The category of HCW, having searched for information on resistant bacteria, and having taken care of case patients were associated with better knowledge. The HCW category, age, type of unit, seniority, and having taken care of case patients were associated with risk perceptions. Qualitative analysis identified 61 themes. HCWs were extremely concerned by the spread of bacteria within the hospital. The main challenges identified were organizational and communication issues. Conclusion HCWs reported a lack of knowledge and a lack of resources to implement guidelines. Strategies to improve guidelines implementation must be based on a better availability of resources, better communication, and new educational methods.

The cryoline system at ITER forms a very complex network localized inside the Tokamak building, on a dedicated plant bridge and in cryoplant areas. The cooling power produced in the cryoplant is distributed via these lines with a total length of about 3.7 km and interconnecting all the cold boxes of the cryogenic system as well as the cold boxes of various clients (magnets, cryopumps and thermal shield). Distinct layouts and polygonal geometry, nuclear safety and confinement requirements, difficult installation and in-service inspection/repair demand very high reliability and availability for the cryolines. The finalization of the building-embedded plates for supporting the lines, before the detailed design, has made this project technologically more challenging. The conceptual design phase has been completed and procurement arrangements have been signed with India, responsible for providing the system of cryolines and warm lines to ITER, as in kind contribution. The prototype test for the design and performance validation has been planned on a representative cryoline section. After describing the basic features and general layout of the ITER cryolines, the paper presents key design requirements, conceptual design approach, progress and status of the cryolines project as well as challenges to build such a complex cryoline system.

Fusion of Hydrogen to produce energy is one of the technologies under study to meet the mankind raising need in energy and as a substitute to fossil fuels for the future. This technology is under investigation for more than 30 years already, with, for example, the former construction of the experimental reactors Tore Supra, DIII-D and JET. With the construction of ITER to start, the next step to “fusion for energy” will be done. In these projects, an extensive use of cryogenic systems is requested. Air Liquide has been involved as cryogenic partner in most of former and presently constructed fusion reactors. In the present paper, a review of the cryogenic systems we delivered to Tore Supra, JET, IPR and KSTAR will be presented.

A helium cryogenic compressor was developed and tested in real conditions in 1996. The achieved objective was to compress 0.018 kg/s Helium at 4 K @ 1000 Pa (10 mbar) up to 3000 Pa (30 mbar). This project was an opportunity to develop and test an interesting new concept in view of future needs. The main features of this new specific technology are described. Particular attention is paid to the gas bearing supported rotor and to the pneumatic driver. Trade off between existing technologies and the present work are presented with special stress on the bearing system and the driver. The advantages are discussed, essentially focused on life time and high reliability without maintenance as well as non pollution characteristic. Practical operational modes are also described together with the experimental performances of the compressor. The article concludes with a brief outlook of future work.

For purposes of testing the present LEP superconducting resonant cavities and the future LHC magnets, CERN built a test station the cryogenic power of which is presently supplied by a dedicated 6 kW at 4.5 K helium refrigerator. The thermodynamic cycle is discussed and special emphasis is put on a new cryogenic expansion turbine operating in the liquid phase. Information is given about : the cycle screw compressors’ performances, the general performance of the refrigerator, the expected efficiency enhancement due to the liquid turbine, an off-design turn down operation.