Write the June 4, 2024.
THE case of measles are still increasing in Europe and particularly in France. If not being vaccinated considerably increases the risk of contracting measles, one dose is not always enough and failures are reported after 2 doses, particularly in patients who received the 1st dose.time dose before 12 months. Hence the latest recommendation from the HAS: 2 doses of MMR for all patients born since 1980 and add a 3th dose to those who received the 1time before the age of 12 months. Measles being the most contagious infectious disease, check vaccination records and catch up if necessary!!!!
The evolution of the whooping cough epidemic is also very worrying, particularly in Europe and France. How can we explain this particularly marked rise in recent months?
- While vaccination coverage changes little, whooping cough epidemics evolve in cycles of 3-4 years, reflecting a low-noise circulation of pertussis, immunizing the population in addition to vaccination. The current epidemic is still a consequence of the pandemic, and of the absence of circulation of numerous pathogens which has led to an immune debt…
- Vaccination coverage, excellent among infants born since 1er January 2018 due to the obligation, are correct at 6 and 11 years old but are insufficient for adults.
- Finally, acellular pertussis vaccines, the only ones currently available in France, have suboptimal effectiveness: very effective on “pertussis disease” in the short term, they have little or no effect on the carriage of pertussis. pertussis, and the duration of protection conferred by the vaccine appears shorter than that induced by the natural disease or certain whole cell pertussis vaccines. Remember that while some whole vaccines could be remarkably effective (not all), they were very reactogenic, hampering vaccine combination programs (particularly with pneumococcal vaccines) and difficult to manufacture in a stable manner.
In front of this situation, the most urgent measure is to increase considerably vaccination of pregnant women (current vaccination coverage around 18-20%) to protect newborns and small infants before they have received the first 2 doses of vaccine.
THE congress of the European Society of Pediatric Infectious Diseases (ESPID), the main international vaccinology congress, took place in Copenhagen from May 20 to 24. A number of communications were devoted to the effectiveness on the ground (effectiveness) of the Nirsevimab (anti-RSV monoclonal antibody) in the 4 countries that have been able to implement it: United States, France, Spain and Luxembourg. In each, it was of the order of 75 to 90% for hospitalized bronchiolitis. The two most successful experiences are those of Galicia in Spain and France.
In Galicia, (Number of births/year≃10,000), 85% of infants under one year old were immunized with rigorous monitoring of hospitalizations for bronchiolitis: collapse of hospitalizations for RSV bronchiolitis in this age group while for older children, the epidemic was of usual intensity; the effectiveness was evaluated at 82% (95% CI = 65.6-90.2%)
- In France (Number of births/year≃000), only newborns and those under 3 months have been immunized. On ambulatory formsthe impact among children under 3 months old, assessed using the PARI network, was marked (reduction of 53% compared to the previous year, and decline compared to pre-Covid years) and the effectiveness measured at 79.7% (95% CI 67%-87.3%). Only outpatient effectiveness result published!
- On hospitalized forms, the effectiveness was measured at 83% (95% CI = 73.4-89.2%). For patients who received Nirsevimab and presented with RSV bronchiolitis, the duration of hospitalization and oxygen therapy were significantly shorter.
- Finally, for infants hospitalized in intensive careSanté Publique France measured an effectiveness between 76 and 81% (results not presented at this congress).
The effect of this immunization on other RSV pathologies in infants remains to be clarified: acute otitis media, pneumonia, etc. according to government announcements, Nirsevimab should be distributed in sufficient quantities to immunize children under one year of age, the season next. If you want to have access to interesting communications from ESPID, click on these links: Link 1, Link 2, Link 3.
In response to your questions
I see an 18-year-old girl who thinks she only received one dose of Gardasil® at 14, but she lost her health record. What do you recommend?
In the absence of possible serology, the classic response: ignore it and offer a 2+1 schedule to your age. But a recent study shows that at his age, a 1+1 regimen (at least 6 months apart) has immunogenicity comparable to the 2+1 regimen after the booster dose. We therefore advise you to apply this diagram instead.
Should we delay vaccinations for a 3.5-month-old infant receiving quadruple therapy for non-bacilliferous lymph node tuberculosis?
No !!! Neither the illness nor the treatments received justify it, especially since this child probably comes from a disadvantaged background (more at risk for meningitis, gastroenteritis, etc.)
Robert Cohen, Pierre Bakhache, Pierre Bégué, Marie-Aliette Dommergues, Véronique Dufour, Joël Gaudelus, Hervé Haas, Isabelle Hau, Cécile Janssen, Odile Launay, Maeva Lefebvre, Didier Pinquier, Anne-Sophie Romain, Georges Thiebault, Franck Thollot, François Life of the Wise, Catherine Weil-Olivier
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