[Evolution of strategy and coverage rates for hepatitis B vaccination in France, a country with low endemicity]. / Evolution des stratégies vaccinales et couverture vaccinale contre l'hépatite B en France, pays de faible endémie.

Both HBV plasma derived vaccines and HBV recombinant vaccines have proved safe and highly immunogenic. In France, exhaustive population surveys have revealed a vaccine coverage rate of over 21.7% and very low three-dose vaccine coverage among infants (19.8%), children (23.3%), and adolescents. Among hospital staff, around 80 to 90% of physicians and health care personnel in public or private hospitals were vaccinated against hepatitis B and the level of coverage was higher among personnel accidentally exposed to blood (90 to 100%). Among risk groups, the specific prevention program against mother-infant transmission was unevenly applied, and between 25 to 45% of intravenous drug abusers, prisoners, or STD patients were vaccinated. These coverage rates are inadequate to obtain a significant reduction and control of hepatitis B infections in France. The complete eradication of HBV transmission might take another 20 years to achieve unless great efforts are made to vaccinate the general population (infants especially) and high-risk groups.

Seroprevalence of herpes simplex virus type 2 antibodies in an STD clinic in Paris.

Our objective was to evaluate the seroprevalence of herpes simplex virus (HSV)-2 and HSV-1 in a population of men and women attending the STD clinic of Hôpital St-Louis (Paris, France). Four hundred and eighty-seven patients (264 men and 223 women) were tested for HSV-2 and HSV-1 antibodies by specific enzyme immunoassay (EIA) (Smithkline-Beecham Biologicals). Univariate and multivariate analyses were carried out for correlations with clinical, socio-epidemiological and behavioural data. HSV-2 seroprevalence was 55% (44.7% in men, 67.3% in women). HSV-1 seroprevalence was 93% (94.7% in men, 91% in women). The predictive factors of HSV-2 seropositivity being female (OR: 3.37), age (OR: 1.04), country of origin (Central Africa OR: 3.52, North Africa OR: 1.36), history of genital herpes (OR: 10.97), hepatitis B virus (HBV) markers (OR: 1.92) and hepatitis C virus (HCV) markers (OR: 3.96). The only protective factor was HSV-1 seropositivity (OR: 0.25). The predictive factors of HSV-1 seropositivity were only the country of origin (Central Africa OR: 2.95, North Africa OR: 1.83) and the absence of genital herpes (OR: 11.01). Only 23 (8.6%) HSV-2 seropositive patients had a history of genital herpes. This study underlines the very high HSV-2 seroprevalence of patients with STDs, only a few of whom have a history of genital herpes. Detection and counselling is urgently needed for these patients.

Hepatitis A among health workers in Paris hospitals. Occupational Health Physicians of Paris Hospital (AP-HP)

To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey against hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8 percent (95 percent CI: 44.0-65.6), increasing with age and being higher among Europe (83.6 percent vs 45.6 percent, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (48.8 percent vs 42.6 percent) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2 percent vs 40.1 percent). Seroprevalence was higher in assistant nurses than in nurses (51.3 percent vs 39.8 percent, P < .02). Among cooks and kitchen employees, 53.4 percent were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.(Au)

Hepatitis A among health workers in Paris hospitals. Occupational Health Physicians of Paris Hospital (AP-HP).

To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey of hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8% (95% CI: 44.0-65.6), increasing with age and being higher among employees of African or Caribbean origin than those from Europe (83.6% vs 45.6%, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (46.8% vs 42.6%) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2% vs 40.1%). Seroprevalence was higher in assistant nurses than in nurses (51.3% vs. 39.8%, P < .02). Among cooks and kitchen employees, 53.4% were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.

[Vaccination against hepatitis B in France in 1996]. / Couverture vaccinale contre l'hépatite B en France en 1996.

A national campain aimed at promoting immunization against hepatitis B was launched in 1994. Two years later, a survey was designed to estimate the situation of the hepatitis B vaccination in France. Around ninety per cent of physicians were hepatitis B vaccinated. The rate of vaccinated population among public hospitals personnel were more than 90% and lower in private hospitals (79%). A quarter of the general population was vaccinated and the higher rate (69%) was observed in the 13-20 years young people. Progressively the contribution of the physicians to the vaccination was increasing (89% in 1996). After a selective vaccination of risk groups and the instauration of the prevention of mother/infant transmission, the French programme was extended to cover adolescents and children. The success of the hepatitis B vaccination campain was obtained by the promotion message toward population and physicians.

[Mucocutaneous lymph node syndrome: case report]. / Un cas de syndrome adéno-cutanéo-muqueux.

The muco-cutaneous lymphonode syndrome affecting babies and infants has recently been described in Japan. The children present with sub-maxilliary glands, fever and a characteristic desquamating rash. It is important to make the diagnosis because of the rare but dangerous cardiac complications. The aetiology is unknown but the condition may be related to infantile polyarteritis nodosa.