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Background Trastuzumab emtansine (T-DM1) is indicated as second-line treatment for human epidermal growth factor receptor 2 (HER2)-positive metastatic or unresectable locally advanced breast cancer, after progression on trastuzumab and a taxane-based chemotherapy. We wished to determine if the line of treatment in which T-DM1 is administered has an impact on progression-free survival (PFS) and in particular, if prior treatment with capecitabine/lapatinib or pertuzumab modifies PFS of further treatment with T-DM1. Patients and methods We performed a multicenter retrospective study in 3 Belgian institutions. We evaluated PFS with T-DM1 in patients treated for HER2 positive metastatic or locally advanced unresectable breast cancer between January 1, 2009 and December 31, 2016. Results We included 51 patients. The median PFS was 9.01 months. The line of treatment in which T-DM1 (1st line, 2nd line, 3rd line or 4+ lines) was administered had no influence on PFS (hazard ratio 0.979, CI95: 0.835–1.143). There was no significant difference in PFS whether or not patients had received prior treatment with capecitabine/lapatinib (9.17 vs 5.56 months, p-value 0.875). But, patients who received pertuzumab before T-DM1 tended to exhibit a shorter PFS (3.55 months for T-DM1 after pertuzumab vs 9.50 months for T-DM1 without pretreatment with pertuzumab), even if this difference was not statistically significant (p-value 0.144). Conclusion Unlike with conventional chemotherapy, the line of treatment in which T-DM1 is administered does not influence PFS in our cohort of patients with advanced HER2-positive breast cancer.

Resume L’objectif de reduire les douleurs liees aux vaccins et ainsi, la peur des injections peut passer par des mesures simples et peu couteuses comme l’administration de solutions sucrees (ou d’un vaccin oral contre les rotavirus) ou la mise au sein. En effet, differentes etudes montrent des benefices reels bien que modestes de ces techniques pour les petits nourrissons avec des niveaux de preuve moderes. Neanmoins, la facilite et le faible cout de ces techniques doivent les mettre en premier plan comme le recommande l’OMS et InfoVac.

Les micropolluants (MP) représentent un enjeu environnemental et sanitaire important. Identifier leurs sources pour ensuite réduire leurs rejets est la stratégie privilégiée au niveau français pour lutter contre cette pollution. C’est aussi la démarche qui a été mise en oeuvre dans le projet Regard (réduction et gestion des micropolluants sur la métropole bordelaise). La première phase du projet correspondait ainsi à la réalisation d’un diagnostic territorial, global et intégré couplant à la fois des analyses chimiques et biologiques du milieu naturel et du réseau d’assainissement depuis les points de rejets (station de traitement des eaux usées, exutoires pluviaux, by-pass) jusqu’aux sources d’émission (domestique, industrielle, hospitalière et pluviale). En complément, une caractérisation sociale des sources a été faite afin de comprendre les pratiques, les produits et les usages à l’origine des rejets de MP et d’identifier des leviers d’action pour réduire ces rejets. Les points forts de ce diagnostic sont la complémentarité des approches (sciences de l’ingénieur et sciences sociales, analyses chimiques et biologiques, étude des eaux usées et pluviales) et le nombre important de sites d’étude. La seconde phase du projet correspondait à la mise en oeuvre d’actions de réduction pour les tester et les évaluer du point de vue environnemental (efficacité pour réduire la quantité, la diversité et l’effet des MP), social (appropriation et satisfaction vis-à-vis des solutions) et économique (aide à l’orientation de l’action publique). Les actions ayant eu les meilleurs résultats sont (i) l’action « Familles EAU Défi » sur la source domestique, (ii) les actions de dératisation mécanique, de démoussage des terrains de tennis et d’enherbement des cimetières pour la source collectivité et (iii) l’action de traitement des eaux pluviales strictes en conditions réelles à l’échelle d’un pilote. Le présent retour d’expérience sur ce qui a été fait doit aider les collectivités qui souhaiteraient effectuer une telle démarche à ne pas commettre les mêmes « erreurs » et, au contraire, à mettre en oeuvre directement les actions qui donnent des résultats satisfaisants.

Background Trastuzumab emtansine (T-DM1) is a monoclonal antibody targeting human epidermal growth factor receptor 2 (HER2) receptors, conjugated with a cytotoxic component (a microtubule inhibitor). It is indicated as second-line treatment for HER2-positive metastatic or unresectable locally advanced breast cancer, after progression on trastuzumab and a taxane-based chemotherapy. In HER2-negative metastatic breast cancer, progression-free survival (PFS) declines with each line of therapy, while patients with HER2-positive disease receive the most lines of chemotherapy and the longest duration for every line. We wished to investigate whether the line of treatment in which T-DM1 is administered has an impact on PFS. We also wished to explore whether prior treatment with capecitabine / lapatinib or pertuzumab had an impact on PFS, as none of the patients included in the registration trial had received these treatments before their inclusion in the trial. Methods This is a multicenter retrospective study performed in 3 Belgian institutions. All patients received T-DM1 for HER2 positive metastatic or unresectable locally advanced breast cancer. The primary outcome was PFS with T-DM1, defined as the period between the first administration of T-DM1 and the first radiological or clinical assessment demonstrating progression of the disease. Results We included 51 patients. One patient had to be excluded from the analyses because she no longer had HER positive disease. The median PFS was 9.01 months. The line of treatment in which T-DM1 was administered had no influence on PFS (hazard ratio 0.976, CI95 0.835-1.142). There was no statistically significant difference in PFS between patients who had not received capecitabine / lapatinib before T-DM1 and those who had (9.11 vs 8.91 months, p-value 0.466). Median PFS was 10.07 months when T-DM1 was administered prior to pertuzumab, and 5 months when administered after pertuzumab. Patients who received pertuzumab before T-DM1 thus tended to exhibit a shorter PFS. However, this difference is not statistically significant (p-value 0.096). Conclusions Unlike with conventional chemotherapy, the line of treatment in which T-DM1 is administered does not influence PFS in metastatic breast cancer patients. Citation Format: Duhoux FP, Dufour V, van Maanen A, Berliere M, Taylor D, Canon J-L. Impact of the line of treatment on progression-free survival in patients treated with T-DM1 for metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-32.

Reject brine is the product from desalination processes containing high salinity, high temperature, and at many times, dissolved chemicals. With the growing demand of water, increasing amounts of brine are being produced from the desalination plants leading to significant adverse impacts on the environment. It is necessary therefore to effectively manage desalination reject brine in order to ensure more efficient disposal and reuse. This review gives a general idea on the recent and currently devised brine management processes, which have been employed to reduce the environmental issues related to concentrate dumping. Those management approaches consist of minimization techniques that can be divided into membrane-based, thermal-based and emerging technologies. Moreover, this critical review gives an overview of the various applications of brine and some sustainability aspects of the reject brine disposal and reuse. The most obvious sustainable improvements in reject brine management are based on minimization techniques or reuse that can be achieved through the recovery of valuable materials such as salts, metals, and chemicals. Many new research works in this field have been introduced and scientists have continued to devise reject brine reuse strategies and minimization technologies leading to very low quantities of residual brine.

In this paper, the current and most recent applications of direct contact membrane distillation (DCMD) are discussed. Apart from its rapidly increasing use for the desalination of highly saline feed water, the DCMD is gradually becoming a preferred technology for produced water treatment, purification of groundwater, reclamation of industrial process water, removal of micropollutants from drinking water, juice concentration, and production of chemical products. The fundamentals of the DCMD and governing equations (from heat and mass transfer principles) that describe performance parameters are first explained. Current issues in the DCMD operations such as the influence of membrane type, membrane fouling, and operating conditions on the DCMD performance or productivity are also discussed in this paper. Hybrid systems and renewable energy integration with DCMD systems have been presented as viable solutions that would enhance the sustainability of the DCMD operations.

In this paper, current and recent advances in polymeric and nano-enhanced membrane development for reverse osmosis have been reported in terms of membrane performance and fouling. Graphene, zeolites, carbon nanotubes, silica, silver, and titanium dioxide are the predominantly tested nanoparticles in current and recent investigations. Membranes from graphene, zeolites, and carbon nanotubes have all been shown to enhance membrane water permeability. Silica has been observed to exhibit high affinity for water and improve the hydrophilicity of RO membranes. Silver and titanium dioxide have strong antimicrobial properties and can be included in RO membranes to reduce biofouling. However, the use of nanomembranes for commercial and industrial RO applications is still under development as their scalability is still a challenge. Polymeric membranes, such as cellulose acetate and polyamide, and their integration with other polymers or nanoparticles have also been presented in this paper. Overall, the choice of membrane materials for future RO processes would depend largely on the required permselectivity and the targeted foulants. However, membrane performance and antifouling features would have to be taken into consideration for sustainability of the type of RO membrane desired for a specific application.

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.

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 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.

Nursery areas of European sea bass (Dicentrarchus labrax, L.) were investigated from spring 2005 to summer 2006 in areas along the French Mediterranean coast of the Gulf of Lion. Nurseries were identified by the presence of settling individuals of sea bass and young juveniles. These nurseries represent different types of sheltered shallow habitats, both natural such as coastal lagoons, estuaries, and artificial such as marinas. Settlement occurred from April to June during both years. The number of settling individuals varied between sites from just a few individuals to several thousand. In one given site, settlement also varied between 2005 and 2006. The size distribution of sampled individuals revealed that several pulses arrived in each nursery. At this stage, sea bass already exhibited a strong orientation capacity but a limited swimming ability. The magnitude of sea bass settlement in marinas requires better environmental management of such artificial areas.

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.

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.

Avec une estimation de plus de 75% de la population europeenne vivant en ville en 2020, les consequences de l’urbanisation croissante et des activites anthropiques associees representent un enjeu majeur pour les decennies a venir. La concentration des populations et des activites industrielles et urbaines est responsable d’une forte pression sur le milieu aquatique par l’intermediaire des rejets urbains, vecteurs de multiples polluants. L’evolution de nos modes et niveaux de vie va entrainer une importante augmentation de l’utilisation de nombreuses substances actives. Une partie de ces substances pourra etre liberee dans les ecosystemes avec un impact nefaste sur les especes presentes dont les humains. Connaitre l’origine et l’impact des micropolluants est un enjeu majeur pour en maitriser et en reduire les flux afin de rendre les villes et les territoires plus surs et durables.Dans ce cadre, Bordeaux Metropole et le LyRE/Suez environnement ont mis en place, pour une duree de 6 ans, le « plan micropolluants Bordeaux Metropole » (2013-2018). Ce projet propose une demarche de reflexion globale qui traite la question de la pollution des eaux dans son ensemble, depuis la source de la pollution dans le reseau d’assainissement jusqu’a son devenir dans le milieu naturel. Le « plan micropolluants Bordeaux Metropole » est compose de deux phases. La premiere (2013-2015) consiste a caracteriser et a quantifier les micropolluants dans le systeme d’assainissement de la metropole de Bordeaux. Cette phase doit egalement identifier et comprendre les origines des emissions afin de proposer des leviers de reduction adaptes en fonction des sources. La seconde phase (2015-2018) consistera a initier la mise en place de solutions de reduction des flux de micropolluants sur le territoire et a suivre les actions entreprises.L’objet de cette communication est de presenter la methodologie mise en place, en phase 1, afin d’aider le decideur a caracteriser les substances posant probleme sur son territoire ainsi qu’a identifier les sources principales de ces polluants. Les resultats presentes s’appuient sur le site d’etude de la Jalle de Blanquefort, affluent de la Garonne et riviere periurbaine du nord de l’agglomeration (bassin versant de 347 km²), ayant des enjeux environnementaux importants et de nombreux usages (zone maraichere, zone d’alimentation en eau potable…).

International audience

In application of public policy, parentality teams were created in Paris in June 1998. All ten maternity units of the Paris Hospital Group (AP-HP) participated in developing these teams but staff implications varied between the institutions. Other maternity units in Paris have also instituted parentality teams which are still operating. The Paris Maternal and Infantile Protection administration together with INSERM Unit 149 were charged with the evaluation of these teams. The first phase of "active monitoring" terminated 2001, and discussions between the different teams in October 2004 allowed an analysis of the current situation.

Resume Les infections bacteriennes sont frequentes et sont la troisieme cause de mortalite chez le sujet âge. Leur prise en charge doit tenir compte de particularites bacteriologiques, pharmacocinetiques, et liees aux interactions medicamenteuses. En effet, le risque d’infection a germe resistant est plus eleve chez le sujet âge en raison d’une pression de selection importante par les antibiotiques, rendant necessaire une prescription raisonnee. La posologie de l’antibiotique doit etre adaptee du fait de la presence d’une insuffisance renale physiologique, d’une hypoalbuminemie frequente et d’une moins bonne biodisponibilite au sein de cette population. Il est egalement necessaire de surveiller l’apparition d’effets secondaires plus frequents chez le sujet âge, a savoir l’insuffisance renale avec les aminosides et les glycopeptides, les troubles neurologiques avec les quinolones. Les antibiotiques de choix, parce qu’actifs sur la plupart des germes et bien toleres, demeurent les beta-lactamines.

Resume La pratique de l’immunotherapie specifique par voie sublinguale a ete etudiee par un questionnaire portant sur le nombre d’ISSL, leur duree, leurs indications, les allergenes utilises, l’efficacite dans ces essais ouverts, les concentrations maximales, l’utilisation de premiere intention ou non, les effets indesirables d’apres un listing, la faisabilite et la compliance. Resultats. – Le nombre d’ISSL pratiquees par ce groupe de 11 allergologues a ete de 890 jusqu’a fin 2002. Les allergenes utilises par frequence sont : acariens (44,5 %), pollens de graminees (38 %), betulacees (14 %), autres pollens d’arbres (5 %), chat (3 %). Dans cette serie, les enfants representent 61 % de la population traitee. L’efficacite sur les symptomes persistants de rhinite ou de rhinite + asthme a ete appreciee a trois mois a 36 %, a 6 mois a 50 %, a 1 an a 71 % et a 2 ans a 78 % dans cette etude ouverte. L’ISSL a ete prescrite dans 90 % des cas en premiere intention. La concentration maximale graminees et acariens etait de 300 IR. La duree de la plus ancienne desensibilisation dans cette serie est de 72 mois. Les effets indesirables ont ete : prurit, brulure sublinguale pendant la prise dans 20 % des cas, effets gastro-intestinaux (8 %), œdeme des levres ou de la muqueuse sublinguale (6 %). Aucun choc anaphylactique. L’arret definitif de l’ISSL pour intolerance n’est survenu que dans 3 % des cas.

International audience; The French 2013 immunization schedule having a goal of simplification with comparable efficacy, has decreased the number of injections and removed the injection performed at three months of age in the general population. Apart from the prevention of invasive pneumococcal infections for which it is recommended to maintain three dose primary immunization, vaccination of premature is not addressed in this new calendar. Can the extremely preterm infants (< 33 weeks of gestational age) benefit from this new schedule or should we keep them in three injections schedule? The objective of this paper is to clarify this point through the data available in the literature. Children born prematurely and especially the “extremely premature” born before 33 weeks are at high risk of infections, some of them are preventable by immunization. Although there is no clinical evidence, for pertussis, pneumococcus, Haemophilus influenzae b, hepatitis B, whatever the immunogenicity criteria, immunogenicity is significantly lower in preterm than in term newborn after 3 doses primary schedule. This lower immunogenicity raises concerns about the transition to two doses, about the ability to give short term protection and booster responses. Given these data, GPIP takes the position for maintaining a primary 3-dose vaccination at 2.3 and 4 months for premature infants less than 33 weeks.; Le calendrier vaccinal 2013 répondant à un objectif de simplification à efficacité comparable, a diminué le nombre d’injections recommandées et a en particulier supprimé l’injection effectuée à l’âge de trois mois en population générale. En dehors de la prévention des infections invasives à pneumocoque pour laquelle il est recommandé de maintenir trois doses en primovaccination, la vaccination du prématuré n’est pas abordée dans ce nouveau calendrier. Les grands prématurés peuvent-ils bénéficier de ce nouveau calendrier ou doit-on maintenir chez eux trois injections ? L’objectif de ce travail est de préciser ce point à travers les données disponibles dans la littérature. Les enfants nés prématurément et surtout les « grands prématurés » nés avant 33 SA sont des enfants à haut risque de contracter des infections dont certaines peuvent être prévenues par la vaccination. Pour les valences coqueluche, pneumocoque, Hib, hépatite B quels que soient les critères d’immunogénicité retenus, elle est nettement moins bonne chez les grands prématurés que chez les nouveau-nés à terme. Bien qu’il n’y ait pas de preuve clinique, ceci fait craindre que le passage à deux doses ne permette pas d’une part, de protéger suffisamment à court terme et, d’autre part, laisse craindre une moins bonne réponse immunitaire après le rappel à 11 mois. Compte tenu de ces données, le GPIP prend position pour le maintien d’une primo-vaccination à 3 doses à 2,3 et 4 mois pour les prématurés de moins de 33 semaines.

Since 2004, the French High Committee on Public Hygiene has recommended chickenpox vaccination for first-year medical or paramedical students with no history of chickenpox and with negative serology. A survey was carried out among directors of nurse schools to evaluate both their awareness of these new recommendations and the way in which they had been applied. A questionnaire was sent by mail to each of the directors of the 332 nurse schools identified throughout France. Less than half (41%) of the 147 directors who responded said they were aware of recommendations, and 31% stated they had real knowledge of the recommendations. Only 21% enquire about chickenpox history of students enrolling in their school, and 9% undertake serological assessment of students with no known history of varicella or zoster. More needs to be done both to inform nurse school directors of the vaccine recommendations and to ensure their application.

The export of carbon and carbonate from coral reefs was investigated through a multidisciplinary investigation of the hydrological, geochemical, sedimentological and biological features of Tiahura reef on the northwestern coast of Moorea Island (French Polynesia). The hydrology of the fore-reef is characterised by prevailing longshore western currents and a strong thermocline. As revealed by turbidity structures (benthic and intermediate nepheloid layers) and by the amount of particles collected by near-bottom sediment traps, horizontal and downslope advections of particles dominate over offshore vertical transport. The exported material is rich in carbonate (ca. 80%) and poor in organic matter (ca. 4%). Sedimentation rates at 430 m depth, i.e. definitive export, reached 209.6 mg m-2 d-1 (dry weight). Estimates of carbon and carbonates export for Tiahura reef also reported here represent respectively 47% and 21% of the organic and inorganic carbon produced within the reef.

Coral reefs in Reunion Island are subjected to eutrophication due mainly to anthropogenic activities following urbanisation of the watershed. This study assesses the impact of consequent coral reef degradation on fish communities. A quantitative study on fish communities was conducted on two sectors (undisturbed and disturbed) of a fringing reef. Data were collected using visual census techniques. The ichthyofauna is structured into three main communities (back reef, inner reef and outer reef). No significant difference was found between the undisturbed and disturbed sectors for the outer reef flat communities. Reef perturbation was found to affect fish abundance mainly on the back reef zone. In the undisturbed back reef zone, the overall fish abundance was almost double that in the disturbed one. The fish communities of the former showed higher homogeneity than the latter. Perturbation of the behaviour of the most abundant fish populations of the back reef zone is discussed with respect to their ecological preferences. Species may also be affected by disturbance, owing to their changing habitat and food availability.

In 2008 and 2010, the Comité technique des vaccinations and the Haut Conseil de Santé Publique have not recommended generalized vaccination against rotavirus (RV) in France. The Groupe de Pathologie Infectieuse Pédiatrique (GPIP) and the Association Française de Pédiatrie 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.

Background and Objectives In fetal/neonatal thrombocytopenia, maternal alloimmunization is diagnosed by the identification of the maternal alloantibody and the offending paternal antigen inherited by the foetus/neonate. Today, for practical reasons, most laboratories perform platelet genotyping instead of phenotyping. Here, we report the case of a human platelet antigen (HPA)-5 genotype/phenotype discrepancy observed in a mother who delivered a mildly thrombocytopenic newborn. Materials and methods Platelet antibody detection and platelet phenotyping were performed using the MAIPA assay; platelet genotypes were determined using BeadChip technology (BioArray), PCR-SSP, PCR-RFLP and sequencing. Results Serological investigations revealed the presence of maternal anti-GPIIbIIIa autoantibodies. No alloantibodies were detected. No feto-maternal platelet incompatibility was observed for HPA-1 to -21. The mother and newborn were genotyped as HPA-5aa using BeadChips, but as HPA-5a (weak b) with PCR-SSP and HPA-5ab with PCR-RFLP. Mother's platelets were phenotyped as HPA-5b(+). GPIa exon 13 sequencing confirmed the HPA-5ab genotype of the mother and newborn, and revealed an NM_002203.3:c.1594A>C mutation near the HPA-5 polymorphism (5′ side), leading to an I503L amino acid change. Conclusion Feto-maternal alloimmunization was ruled out: the neonatal thrombocytopenia probably resulted from maternal anti-GPIIbIIIa autoantibodies. This case highlights that platelet typing should be performed using two different methods to avoid false diagnosis.

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

Colonization of the lagoon at Moorea Island, French Polynesia, by fish larvae was studied with a net fixed on the outer reef crest in order to observe die1 and lunar cycles. Fish larvae entered the lagoon at dusk and at night, mainly during moonless periods. Colonization was closely related to decreasing light intensity; it was 4 times greater during new moon than during full moon. Other environmental factors such as hydrodynamic features of the water mass above and in front of the reef crest may have also influenced this colonization. More than 97 % of the larvae that colonized the lagoon were postflexion or later stage larvae and were probably competent to settle in the lagoon. Gobiidae were the most numerous with 60.5 % of the catches. Scandae and Labridae were the second and the third most important families with 10.3 and 6.2% of the catches respectively.

Work from the last decades indicates that animals possess mental states, and build some representation of their world. But can animals reason from abstractions, concepts, and unobservable forces? Animals appear capable of extracting general rules from observed associations. Some species can generate adequate solutions to problems by reasoning about missing elements and even recognize causal agents. One of the limits that can be detected both in the physical and social domains of animals is the lack in capacity to retrospectively explain the relation about events, especially when this relation calls upon unobservable forces such as gravity, solidity, or mental states of others.

The significance of the site of platelet sequestration in determining the indication for splenectomy in idiopathic thrombocytopenic purpura (ITP) is a controversial subject. However, most of the negative conclusions are based on 51chromium labelling of homologous platelets. We report here the results of an analysis of 222 cases in which the kinetic study of 111indium-oxinate-labelled autologous platelets was performed under homogeneous technical conditions. 103 of these patients subsequently underwent splenectomy. This study demonstrates that the site of platelet sequestration in active ITP constitutes a variable independent of the patient's age, history of the disease and its severity (platelet count, lifespan). The sequestration site is a good predictive element of the short-term efficacy of splenectomy (71/76 cases with splenic sequestration obtained a platelet count exceeding 100 x 10(9)/l versus 7/13 cases with mixed sequestration and 1/14 cases with hepatic sequestration), and the long-term results (6 months to 5 years after splenectomy) do confirm the clinical value of this study.

Since 2004, the French High Committee on Public Hygiene has recommended chickenpox vaccination for first-year medical or paramedical students with no history of chickenpox and with negative serology. A survey was carried out among directors of nurse schools to evaluate both their awareness of these new recommendations and the way in which they had been applied. A questionnaire was sent by mail to each of the directors of the 332 nurse schools identified throughout France. Less than half (41%) of the 147 directors who responded said they were aware of recommendations, and 31% stated they had real knowledge of the recommendations. Only 21% enquire about chickenpox history of students enrolling in their school, and 9% undertake serological assessment of students with no known history of varicella or zoster. More needs to be done both to inform nurse school directors of the vaccine recommendations and to ensure their application.

International audience; AIM: To study in a sequential prospective trial, the effect of cheese consumption on the emergence of Escherichia coli and enterococci resistance to amoxicillin after amoxicillin-clavulanic acid (amoxiclav) treatment. METHODS AND RESULTS: The study comprised two phases separated by 1 year. Each phase lasted 75 days for each volunteer (from day -13 to day 61). During the first phase, 18 healthy volunteers were given a 1-g dose of amoxiclav orally twice a day for 5 days (from day 0 to day 4). The design of phase 2 was identical to that of phase 1, except that the volunteers consumed 100 g of hard-cooked cheese from day -6 to day 19. Faecal samples were collected 20 times throughout the trial and were quantitatively assayed for total and amoxicillin-resistant (Amox(R)) E. coli and enterococci. The consumption of experimental cheese was associated with a decrease of Amox(R) enterococci during the post-antibiotic period, with the maximum level of Amox(R) enterococci falling from 6.2% to 0.03%. This effect was not observed for E. coli, and the type of cheese (raw milk vs pasteurized milk) did not influence the results. CONCLUSIONS: Consumption of cheese during amoxiclav treatment reduces the emergence of Amox(R) enterococci in faeces. SIGNIFICANCE AND CLINICAL IMPACT OF THE STUDY: Our clinical pilot trial suggests that there are likely to be benefits from consuming probiotic-containing cheese during antibiotic treatment.

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 sheep genome contains 60 to 90 V lambda genes distributed in least 6 different families, whereas 37 V lambda genes and 10 families exist in humans. Comparison with human V lamda sequences indicates that sheep V lambda genes display less overall sequence divergence, but are closer to the genes most frequently used in the human peripheral repertoire. In both species, 2 to 3 genes contribute half of the expressed sequences. Therefore, similar large combinatorial potential and restriction of the expressed repertoire can exist in two species whose strategy of diversification differs widely (ongoing rearrangement throughout life in human bone marrow vs postrearrangement diversification during early development in sheep ileal Peyer's patches).

In application of public policy, parentality teams were created in Paris in June 1998. All ten maternity units of the Paris Hospital Group (AP-HP) participated in developing these teams but staff implications varied between the institutions. Other maternity units in Paris have also instituted parentality teams which are still operating. The Paris Maternal and Infantile Protection administration together with INSERM Unit 149 were charged with the evaluation of these teams. The first phase of "active monitoring" terminated 2001, and discussions between the different teams in October 2004 allowed an analysis of the current situation.

Described here are two cases of cerebral aspergillosis successfully treated with voriconazole after the failure of first-line treatment with amphotericin B deoxycholate. In both cases, clinical and radiological cure was achieved within 6 weeks. Voriconazole should be considered as first-line therapy for cerebral aspergillosis.