Bulletin N°11 – October 2024

The news is dominated by respiratory infections and their prevention.
RSV and bronchiolitis: Although the epidemic is late compared to last year, the first cases of RSV bronchiolitis are reported by the PARI network (

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). It is time to vaccinate pregnant women who wish it or to immunize infants with Nirsevimab, not only those born since September 1, but also those born before the season. The HAS recommendations specify: “All those born from 01/01/2024”.
The annual flu vaccination campaign seasonal started on October 15, 2024:

• 3 injectable tetravalent vaccines available: Fluarix tetra®, Influvac tetra®, Vaxigrip tetra® but neither the live nasal vaccine (Fluenz®) nor the high dose vaccine (Effluelda). Compared to last year, only the H3N2 A/Thailand/8/2022 strain has changed. From next year, we will return to trivalent vaccines, the B/Yamagata strain no longer circulating in the world.
• Must be vaccinated: all subjects at risk from the age of 6 months (

  
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  ), healthcare professionals, and since 2022, vaccination can be offered to all children aged 2 to 18 without comorbidity (65% health insurance reimbursement supplemented by mutual insurance companies). In the absence of the nasal vaccine, obtaining significant vaccination coverage seems a challenge.

• Frequently asked questions about influenza and its vaccines are available by clicking on this

  
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  .

For COVID, the only vaccine available is Comirnaty JN1® in 2 dosages 30 mcg and 10 mcg (child). The list of subjects at risk and vaccination schedules are available (

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). Of course, both Covid and Flu vaccines can be administered on the same day.

The whooping cough epidemic continues. Certainly the peak has passed, but the number of cases remains well above that of previous years (

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). Vaccinate pregnant women, vaccines small infants strictly at recommended ages (8 and 16 weeks then 11 months), vaccinate at other recommended ages: 6, 11, 25, 45, 65, 75 years… As Revaxis® (dTP) is no longer available, this makes it possible to increase pertussis vaccination coverage. .

Finally the mRESVIA®, mRNA vaccine against RSV, obtained from the HAS the same recommendations in subjects aged > 75 years and between 65 and 75 years if cardiac or respiratory pathology as Abrysvo® and Arexvy®. It is not yet available.

On the product side. Engerix B20®, Havrix 720®, Infanrix quinta® vaccines made available in September. On the other hand, supply tensions for Boostrix tetra®

In response to your questions.

A kidney transplant patient developed severe ophthalmic shingles following covid. How long should we wait before vaccinating? A cohort study found an incidence of recurrence of ophthalmic shingles after vaccination with Shingrix of 37.7 per 1,000 person-years, compared to 26.2 for the unvaccinated group (JAMA Ophthalmology, 02/2024). After adjustment, the risk of exacerbation of ophthalmic zoster over the 56 days increased 1.64-fold after vaccination. The etiology of reactivation of ophthalmic zoster is unclear, but reactivation may be due to an immune response to VZV or an active viral infection. The CDC has not included this element in the contraindications or precautions for use of the vaccine, while Canada's immunization guide states that “At present, data are insufficient to assess the risk associated with to the recurrence of ophthalmic zoster in people who received RZV. » The HAS recommendation was prior to this publication. A delay > 3 months and the green light from the ophthalmologist seem reasonable.

I use COVID, RSV, Flu rapid diagnostic tests. I sometimes have positive tests in children with pneumonia or otitis. Does this allow us not to prescribe antibiotics? No !!! Influenza and RSV are major providers of pneumococcal infections through different mechanisms (Besteman SB, Lancet Respir Med. 2024 July). It is on clinical criteria (age, intensity of symptoms, sometimes for pneumonia, imaging and/or biological markers) that antibiotic therapy is decided.

Do Chickenpox vaccines protect against Shingles? Oui ! If they were done before the child contracted chickenpox. Maybe ! If they are administered to children who have had chickenpox before the age of one year (we know that the disease in the first months of life causes lower immunity and exposes them to an increased risk of shingles and second chickenpox). Probably no! If chickenpox occurred after the age of one year: to be effective, Zostavax® included 14 times the dose of the vaccine virus to protect against shingles.

The InfoVac site has had a makeover with many new documents:

1. A vaccinology training slideshow with hundreds of slides,
2. Answers to the questions asked by hesitant parents,
3. Slides from the last Pediatric Infectious Pathology Day on October 5.

Robert Cohen, Maeva Lefebvre, Pierre Bakhache, Pierre Bégué, Marie-Aliette Dommergues, Véronique Dufour, Joël Gaudelus, Isabelle Hau, Cécile Janssen, Didier Pinquier, Anne-Sophie Romain, Georges Thiebault, Franck Thollot, François Vie le Sage, Catherine Weil -Olivier, Odile Launay, Hervé Haas.

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