[Life-threatening sleepwalking (Elpenor's syndrome) in a 10-year-old child]. / Somnambulisme avec mise en danger vital (syndrome d'Elpénor) chez un enfant.

Though benign in the majority of cases, sleepwalking sometimes causes injuries due, among other causes, to falls. Such accidents can be life-threatening - a situation that has been termed Elpenor syndrome (in reference to an accident experienced by a character in Homer's epic The Odyssey) - in particular when entailing defenestration. This syndrome has been described in adults and adolescents; we report here a case in a child. OBSERVATION: This 10-year-old girl was admitted at night to our hospital after a 3-m fall at home. She was alert (Glasgow score, 15) at admission; a frontal wound and a deformation of the right wrist were noted. Brain CT scans showed a frontal skull fracture and frontal lobe contusion, wrist x-rays showed a displaced right fracture. The patient underwent urgent neurosurgery (wound excision and suture after reduction of skull fracture) and closed reduction and immobilization of the wrist fracture, both under general anesthesia. She underwent a psychiatric assessment in the intensive care unit 3 days after her fall. She was alert, well-oriented in time and space, and spoke fluently. She had no memory of her fall, only remembering going to bed in the evening before the accident and waking up in the ambulance on the way to the hospital. She displayed no sign of a concurrent mental illness and no suicidal ideas. Her parents reported that the evening of the accident she and her two brothers had all fallen asleep about 11:00 pm while watching TV, in the double bed of the guest room, placed just beside its window. At approximately 1:00 am, her father, who was going to bed and had just made noise in the hall, heard a cry from the guest room. He entered the room immediately and saw the opened window and his daughter lying on the outside ground; the brothers only awakened after the fall. The family had returned 2 days before from a 6-month stay in the United States, with jet-lag, sleep deprivation, and a disorganized sleep/wake rhythm in the patient. There was no medication before the accident, no substance use (including caffeine), and no concurrent medical problem. Over the 2 preceding years, the patient had undergone two witnessed episodes of early-nighttime arousal with altered consciousness and calm wandering (including going downstairs on one occasion), both strongly suggesting sleepwalking. There was a history of sleepwalking in her father and her older brother. Life-threatening sleepwalking (Elpenor syndrome) was diagnosed. The child and her parents were educated about sleepwalking; regularization of sleep schedules and sleep extension (avoidance of sleep deprivation, short napping when possible) were prescribed. We also recommended securing the home (bed, windows, and stairways). No pharmacological treatment was instituted. During the following 18 months, the child manifested only one noted sleepwalking episode, without risk-taking. She had no neurological or psychopathological sequela from her accident, of which she never had a memory. CONCLUSION: Elpenor syndrome can occur in a child; consequently, it is important to inform parents of children with sleepwalking about the necessity of always securing the night-time environment.

[Immunisation coverage in the adult workforce 2003. Utilisation of routine occupational health checks to ascertain vaccination coverage in employees]. / Initiativen zur Steigerung der Impfbereitschaft in Schleswig-Holstein - Impfschutz bei Erwachsenen in der Arbeitswelt 2003Nutzung von arbeitsmedizinischen Routineuntersuchungen zur Erfassung von Impfraten unter Beschäftigten.

The immunisation campaign from February to December 2003 in the federal state of Schleswig-Holstein focused for the first time on the immunisation coverage in adults in the workforce. During routine occupational health checks vaccination against diphtheria, tetanus, poliomyelitis, measles, mumps, rubella, hepatitis A and B (according to vaccination certificates) as well as vaccinations carried out on site (active duty) were documented. We received 12,770 anonymous and completed questionnaires including 4167 from healthcare workers (with immunisation certificate 11,260 and 3776, respectively). The campaign was useful in several respects: (1) For the first time data on the immunisation coverage of the active work-force became available for Schleswig-Holstein. (2) The acceptance of vaccinations by the employees was increased in general and also influenced family members. (3) Occupational health physicians can close important gaps in immunisation coverage. The results show that (1) immunisation coverage was higher in women, young adults and health-care workers and (2) if a vaccine is available, then acceptance is also present. Within the joint effort of the continued regional vaccination campaign waged since 1999, the previous focus of the campaign's activities (children and adolescents) has now had a positive impact on vaccination coverage in the age groups under 20 years and up to 29 years.